This position is responsible for supervising clinical staff involved in a variety of clinical operations such as Utilization Management, Case Management and/or Disease Management.
Responsible for hiring, training, performance reviews, pay administration, change management and ensuring staff meet/exceeds goals and initiatives.
Implement processes, procedures and initiatives and monitor results, ensure delivery of effective customer service, ensure department is meeting account contracts, and work across the organization in delivery of services to the customer.
* Registered Nurse (RN), with current, unrestricted license to practice in state of operations.
* 2 years clinical experience with direct clinical care to the consumer.
* 2 years utilization review/ managed care experience.
* Leadership skills.
* Knowledge of managed care program policies and procedures.
* Knowledge of managed care and insurance industry.
* Verbal, written, and interpersonal communication skills.
* PC proficiency to include Word, Excel, PowerPoint.
* Analytical skills and sound clinical judgment.
* Case Management Certification (URAC accredited certification) or obtain URAC accredited case management certification within three year of employment if overseeing case management operations.
PREFERRED JOB REQUIREMENTS:
* Supervisory experience.
* Bachelor degree.
* Long Term Supports and Services and/or Service Coordination managed care experience.
* Experience with NM Medicaid Programs.
Job ID: LEO-1024338