Description
At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.
Join HCSC and be part of a purpose-driven company that will invest in your professional development.
This position is responsible for leading and managing the development, implementation, strategic day-to-day administration of managed care operations across clinical functions (care management, case management and disease management). Establish and lead teams in the execution of providing clinical operations support to clients to include: oversight, processes, procedures and direction for managed care activities. Serve as champion of clinical operations to ensure that HCSC's clinical operations teams enhance the effectiveness, quality and client service objectives our clients expect. This position will assist in the development (along with business leaders and clinical leadership), processes that ensure the HCSC's clinical operations is compliant with internal and external requirements.JOB REQUIREMENTS:
- Required Licensed Registered Nurse (RN).
- 2 years of experience in a clinical/surgical setting,
- Required 3 years of management experience.
- Current experience in utilization management position to include pre-authorization, utilization review, concurrent review, discharge planning, and/or skilled nursing facility reviews.
- Knowledge of medical management/nursing practices.
- Analytical skills including presenting clinical/operational recommendations to executive management, Medical Directors, or external clients.
- Problem solving skills.
- Presentation skills including presenting information clearly, concisely, and in a positive manner to internal and external customers.
- Knowledge of Utilization Management metrics, HEDIS and regulatory bodies such as NCQA and URAC.
- Microsoft Office experience.
PREFERRED JOB REQUIREMENTS:
- Experience in the success in leading clinical teams to excellence with objective outcomes.
- Registered Nurse (RN) with 2 years direct clinical experience to the consumer.
- 3 years of management experience in a managed health care setting.
- Certification in CM.
- Bachelor's or advanced degree in nursing or Healthcare field.
This is a Flex (Hybrid) role: 3 days in the office; 2 days remote.
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Compensation: $90,900.00 - $164,200.00
Exact compensation may vary based on skills, experience, and location
HCSC Employment Statement:
We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
To learn more about available benefits, please click https://careers.hcsc.com/totalrewards
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