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.

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Job Summary

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, Case Management and Disease Management). 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 HCSC’s 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 HCSC’s clinical operations customer service is compliant with internal and external requirements.

JOB REQUIREMENTS:

• Required Licensed Registered Nurse (RN)

• 2 years of experience in a clinical/surgical setting,

• Required 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

PREFERRED JOB REQUIREMENTS:

• 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

This is a Flex position (3 days in the office)
Relocation assistance will not be provided for this position.

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

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.

Base Pay Range

$88,700.00 - $160,200.00