Sr Manager Clinical Operations

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Job Summary

This position is responsible for leading and managing the development, implementation, strategic day-to-day administration of managed care operations across clinical functions (utilization 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 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 clinical operations customer service is compliant with internal and external requirements.

Leading a team of client facing Clinical Account Consultants responsible for membership retention and growth with ASO employer groups.

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 :

3 years of management experience in a managed health care setting

Client-facing experience.

Knowledge of Business Acumen.

Experience in role as strategic clinical consultant or clinical account executive.

Strategic project management experience including development, implementation, evaluation and follow-up.

Knowledge of the Health and Wellness Marketplace and Programming.

Strong organizational skills and the ability to interact with numerous internal departments and keep abreast of products and service deliverables.

Prior experience participating in and supporting RFPs for clients.

Experience as a Strategic Clinical Account Consultant / Executive in the Health and Wellness industry.

Experience working with large, complex national clients.

Experience analyzing and presenting clinical information and program performance data and recommended course corrections.

Experience presenting and working with major consulting firms.

Certification in UM, CM or DM

Bachelor's or advanced degree in nursing or Healthcare field

This is a Flex position, in the office 3 days a week

Position will be filled in Houston, TX; Richardson, TX; Albuquerque, NM or Tulsa, OK

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

HCSC Employment Statement :

We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, 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.

Base Pay Range

$88,700.00 - $160,200.00