Job ID: BDP-1027435 Description:
At HCSC, building a talent engine for the future is a key priority because we recognize that as our business evolves to reflect the changing world, we must adapt our workforce to meet this challenge. Additionally, with "excellence" one of our core values, we are focused on improving our success measures and delivering the best possible customer experience.
This position is responsible for directing the execution and delivery of specific health care management programs; establishing cost-containment goals, objectives, metrics, and Return on Investment (ROI) targets for the Health Care Management Programs; ensuring compliance with all certification and accreditation entities (DOI/URAC/NCQA) as well as government (HIPAA/ERISA/Department of Labor) programs; representing the company and the Division before internal and external customers; managing operations for medical care programs to support effective utilization and support organizational strategies. Oversee director level personnel and other upper management in the operations of the health care programs.
Clinical license (RN, LPC, LMSW, LISW) currently licensed with 3 years clinical nursing experience.
10 years of health insurance experience in Utilization Management, Case Management or Quality Management.
9 years management experience including budget, strategy development and execution of initiatives.
Ability and experience in influencing, leading and directing teams in multiple functional areas.
Project management experience in the planning, implementation, and controlling of Medical projects.
Knowledge of various accreditation standards, i.e., NCQA, URAC, etc.
Knowledge of managed care principles and delivery systems.
Familiar with claims payment rules and their impact on care management processes.
Knowledge of healthcare/insurance industry (external market) current and future trends, to assess future market needs.
Knowledge of service delivery processes, workflow, systems, reporting needs, training and quality.
Strong organizational skills and ability to function cooperatively to achieve organizational goals and objectives.
Effective communication, leadership, teambuilding, and quantitative analysis skills.
PC proficiency including various software programs i.e., Work, Excel, PowerPoint, Access, etc.
Ability and willingness to travel, including overnight stays, as needed.
PREFERRED JOB REQUIREMENTS:
Certification in Case Management, Health Care Administration or Project Management
Advanced degree in business, public health, administration or other business field.
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Expertise Nursing Job Type Full-Time Regular Location IL - Chicago, TX - Richardson