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.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

This position is responsible for directing the execution and delivery of specific health care management programs; establishing value improvement goals, objectives, metrics, and other key performance targets for government programs clinical operations; ensuring compliance with all applicable certification and accreditation entities as well as government regulators; 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 government programs clinical operations.

JOB REQUIREMENTS:

•  Clinical license (RN, LCPC, LMSW, LISW) currently licensed with 3 years experience in a clinical setting.

• 10  year management experience.

• 15 years health insurance experience in Utilization Management, Case Management or Quality Management.

• Knowledge of traditional Medicare, or Dual Eligible, or Medicaid claims payments rules and their impact on care management processes. Experience developing business requirements and reporting.

• Project management experience in the planning, implementation, and review of medical processes.

• Knowledge of accreditation standards (ie; NCQA or URAC).

• Experience in the creation, development and implementation of process improvement and instilling that focus in a
  team.

• Experience developing high-level strategies; strategic thinker and implementer.

• Knowledge of managed care principles and delivery systems.

• Knowledge or experience with quality improvement.

• Knowledge of healthcare/insurance industry, trends, regulations and future market needs.

• Knowledge of managed care service delivery processes, workflow, systems, reporting needs, training and quality.

• Collaborative leadership and teambuilding skills including influencing, leading and directing individuals in multiple functional areas.

• Analytical skills.

• Verbal and written communication skills including interpersonal skills and skills to develop and facilitate presentations to management and executives.

• PC skills and experience to include Excel, PowerPoint, and Access.

• Ability and willingness to travel, including overnight stays.

PREFERRED JOB REQUIREMENTS:

• Advanced degree in business, public health, administration or other business field.

• Certification in Case Management, Health Care Administration or Project Management.

• Clinical leadership and management experience focused in serving the elderly, chronically ill, disabled, low income or frail population.

• Medicare Advantage or Dual Eligible or Medicaid experience.

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.