Manager, Clinical Operations

3 weeks ago

Albuquerque, United States HCSC Full time

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 supervising clinical staff involved in a variety of clinical operations such as risk management and clinical appeals. Responsible for hiring, training, performance reviews, pay administration, change management and ensuring staff meet/exceeds goals and initiatives. Implement processes, procedures and initiatives and monitor results, ensure delivery of effective customer service, ensure department is meeting account contracts, and work across the organization in delivery of services to the customer.

*THIS IS A FLEX POSITION FOR THE ALBUQUERQUE, NM. OR TULSA, OK HEADQUARTERS. IT IS NOT A TELECOMMUTER POSITION.
* MANAGEMENT (WITH DIRECT REPORTS) EXPERIENCE IS A MUST.
*UM (UTILIZATION MANAGEMENT) EXPERIENCE IS A MUST
**MUST BE WILLING TO WORK SOME WEEKENDS AND SOME HOLIDAYS**
**WORK HOURS ARE 8 AM TO 5 PM MST/CDT**

JOB REQUIREMENTS:
* Registered Nurse (RN) with current license in good standing in the state of operations (New Mexico or Oklahoma) AND 4 years clinical managed care experience
* 2 years supervisory (with Direct Reports) experience in a managed care role.
* 2 years clinical experience with direct care to the consumer years in medical-surgical nursing or Home Health Care.
* Knowledge of nursing practices.
* Analytical skills.
* Experience developing and maintaining self-directed work teams.
* PC experience to include Microsoft Word, Excel, PowerPoint and databases.
* Experience developing recommendations to executive management and/or clients.
* Interpersonal and problem-solving skills.
* Presentation skills to present information clearly, concisely, and in a positive manner to internal and external customers.
* Knowledge of UM Metrics, HEDIS, NCQA and URAC.

PREFERRED JOB REQUIREMENTS:
* Clinical Certification in the approved URAC certification listing.
* Bachelor or advanced degree.

The Compensation/Salary offered for this Position will vary depending on Job-related skills, education, knowledge and experience. This role aligns with an Annual Incentive Bonus plan.

#LI-Hybrid


INAK

Relocation assistance will not be provided for this position.

Sponsorship will not be provided for this position.

We encourage people of all backgrounds and experiences to apply.

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.

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