RN Health Services Sr Specialist

5 - 7 years experience  •  Business Services

Salary depends on experience
Posted on 10/25/17
Chattanooga, TN
5 - 7 years experience
Business Services
Salary depends on experience
Posted on 10/25/17

Plans, organizes, and manages case management, utilization review, and quality activities of clinical and non clinical staff. Develops and implements action plans to improve utilization and quality for Medicare Advantage customers.

Required Skills

Must be able to directly supervise, lead, and manage clinical and non clinical staff  in field based positions. Responsible for assisting in the development, implementation, and management of health services goals and objectives. Provides guidance and supervision to staff related to clinical issues, community resources, and collaborative relationships with customers.  Applies knowledge of utilization review and case management activities.  May be responsible for increasing patient compliance through education to optimize heath and minimize complications and exacerbation.  Responsible for process improvement implementation, quality initiatives, and daily operations of the department.  Performs updates to policies and procedures that are compliant with CMS requirements and NCQA/URAC/CMSA/ state Medicaid requirements.  May audit and must comply with corporate, federal, and state policies, procedures, and confidentiality standards.  Conducts analysis on department statistics and creates reports on the findings.  May act as a liaison with internal departments, outside entities, including physicians, hospitals, health care vendors, social service agencies, member advocates, and regulatory agencies. Leads departmental meetings and cross departmental projects.

Required Experience

Minimum Requirements:  Bachelor’s degree or certification in relevant practice areas. Minimum of 2 years’ experience in management of people and 5 years clinical experience.

 

Qualifications

Required Experience

Minimum Requirements: Bachelor’s degree or certification in relevant practice areas. Minimum of 2 years’ experience in management of people and 5 years clinical experience.

17009050

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