Sr Manager Clinical Operations

Health Care Service Corporation•Helena, MT

6d•$92,700 - $167,500•Hybrid

About The Position

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, Quality Management, Project Oversight, Accreditation Readiness). 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 FEP 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 FEP clinical operations are compliant with internal and external requirements.

Requirements

Licensed Registered Nurse (RN).
2 years of experience in a clinical/surgical setting.
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.

Nice To Haves

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 UM, CM or DM.
Bachelor's or advanced degree in nursing or Healthcare field.

Responsibilities

Leading and managing the development, implementation, strategic day-to-day administration of managed care operations across clinical functions (Utilization Management, Quality Management, Project Oversight, Accreditation Readiness).
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 FEP clinical operations teams enhance the effectiveness, quality and client service objectives our clients expect.
Assist in the development (along with business leaders and clinical leadership), processes that ensure the FEP clinical operations are compliant with internal and external requirements.