(RN) Director, Service Coordination

Cigna   •  

Bedford, TX

Industry: Healthcare


8 - 10 years

Posted 26 days ago

Summary: Clinical Operations Manager is responsible for managing and ensuring the delivery of service coordination and care coordination functions in a given service area(s) following the model of Cigna-HealthSpring. Essential Duties and Responsibilities: • Leads, directs, and monitors the delivery of all service coordination and care management functions. • Develops & ensures implementation of procedures and policies related to services and covered benefits and the structure of the program • Provides leadership and collaboration with other Health Services Leads to assure compliance with local, state and federal regulations, nursing practice standards as well as standard operational structure across Texas. • Effectively partners with Network Operations, Shared Services, Compliance and other business partners in implementing the program • Ensures effective and efficient budget management in providing the best utilization of resources. • Provides effective staffRequired Qualifications: • Must be a Registered Nurse with a current, unrestricted Texas License • Bachelor’s Degree in Nursing • At least seven years’ experience in management or administration; four of which in a director role. Experience managing a remote staff. • Current or previous experience in Medicaid & Medicare managed care • Previous STAR+PLUS experience • Experience with care management software applications • Strong organizational and time management skills; & verbal, written, communication and presentation skills • Strong computer skills using MS Office products including Word, Excel, Power Point, and Outlook • Intermediate to expert knowledge of MS Excel • Ability to meet deadlines and manage multiple priorities Preferred Knowledge, Skills, Abilities: • Master’s Degree in Nursing preferred • Certified Case Manager preferred • Experience managing members with chronic disease processes • Experience working with communit