Vacancy expired!
Description: We are the Health Care Management division of HCSC — a team of dedicated nurses, doctors and other clinicians. Everything we do, and every decision we make, aims to help our members live their most healthy lives. We treat the whole person with integrated pharmacy, physical and mental health care benefits. We’re also tackling the social determinants of health by creating non-clinical partnerships in the communities where we work and live, because everyone should have access to quality health care. We use innovative tools and approaches to help members get the most out of their plan benefits, as affordably as possible. We are more than a health care insurer and we are truly anchored in our purpose: to do everything in our power to stand by our members in sickness and in health.Note: This is an in-office based position in Albuquerque.Job Purpose: This position is responsible for oversight, directing, and supporting clinical operations in physician practices, community-based partners and/or delegated care coordination entities to review care planning and health care outcomes. Consult with physicians/partners or delegates on health care outcomes including developing and analyzing reports. Monitor delegate vendor processes and recommend improvements. Serve as liaison between the practices, partners and/or delegates, Network Management and Health Care Management.Required Job Qualifications: Bachelor degree OR clinical licensure (RN, LISW, LMSW, LPC, RD, etc.) with unrestricted, current clinical license in the state of operations. 3 years of experience in one or more of these fields: managed care operations, case management, customer quality of care in clinical settings, public or government health sponsored programs. Leadership experience and skills. Knowledge of medical terminology and procedures. Knowledge of accrediting body requirements (i.e., - NCQA, EQRO). Verbal, written and interpersonal communication skills. Analytical skills and sound judgment. PC proficiency to include Microsoft suite of applications. Ability and willingness to travel including overnight stays. Possess reliable transportation and applicable insurance to travel to delegate offices, etc.Preferred Job Qualifications: Knowledge of/ experience with Medicaid/Medicare benefits / programs i.e. traditional Medicare, dual eligible populations. Experience in program development and driving results of managed care or related program(s).CACBLocation: NM - Albuquerque Activation Date: Monday, September 2, 2019 Expiration Date: Tuesday, October 1, 2019 Apply Here
