Manager Clinical Support

Texas Children's Hospital • Houston, TX

9d

About The Position

We are searching for a Manager of Clinical Support. This position is responsible for assisting with the interpretation of federal, state, and other regulations and requirements related to all Medicaid products, and coordinating/providing the necessary reporting requirements in a timely manner. Responsibilities include direct and indirect supervision or clinical and non-clinical team members.
Think you've got what it takes?

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.

To join our community of 15,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities.

Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

Requirements

• Bachelor's Degree in Nursing required
• RN - License-Registered Nurses from Texas Board of Nursing or Nurse Licensure Compact required
• 4 years Business Operations in a Healthcare or Insurance Environment, or Nursing Managed Care experience required

Nice To Haves

• Management/Leadership experience preferred

Responsibilities

• Develops strategies, policies, and procedures to ensure regulatory compliance.
• Ensures appropriate communications and partners with others both within and across teams to accomplish goals.
• Provides data and reporting on productivity and other metrics.
• Develops and implements process improvement initiatives, both clinical and non-clinical.
• Ensures quality calls and key performance metrics are met and adhered to according to any internal or external requirements for the call center.
• Manage the Quality of the Care Coordination Team at the Health Plan using nursing/clinical knowledge
• Manage and oversee the actions taken as the result of audits and/or member complaints, ensuring appropriate actions are taken.
• Ensure the timely and accurate completion of all state reporting requirements for Care Coordination quality reporting.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager