Position: Director Care Management – Oklahoma Medicaid
This position is responsible for directing the Oklahoma Medicaid Care Management and Population Health Program. This includes supporting the design, implementation, and ongoing operations of a person-centered care model to ensure the coordination of services to address physical, behavioral, pharmacy, and social needs. The director will lead the implementation of clinical interventions; optimize the clinical review process across operations; ensure program maintains compliance with accreditation standards and government regulations; direct and develop cost of care initiatives and clinical management tools ensuring that quality, expense and performance drivers are operational; direct quality analysis, performance analysis, and customer service satisfaction standards and metrics of Clinical Operations teams; and oversee performance measures and implementing performance improvement plans to address variances.
* Registered Nurse (RN) with current, valid license in Oklahoma.
* 3 years clinical nursing experience.
* 5 years people management experience.
* 8 years medical management experience.
* Experience and skills in influencing, leading and directing individuals in multiple functional areas.
* Project management experience in the planning, implementation, and controlling of Medical projects.
* Knowledge of various accreditation standards, i.e., NCQA, URAC, etc.
* Knowledge of managed care principles and delivery systems.
* Familiar with claims payment rules and their impact on care management processes.
* Knowledge of healthcare/insurance industry (external market) current and future trends, to assess future market needs.
* Knowledge of Customer Service processes, workflow, systems, reporting needs, training and quality.
* Organizational skills and ability to function cooperatively to achieve organizational goals and objectives.
* Communication, leadership, team building, and quantitative analysis skills.
* PC proficiency including familiarity with various software programs i.e., Work, Excel, PowerPoint, Access, etc.
PREFERRED JOB REQUIREMENTS:
* Medicaid experience
* Certification in Case Management, Health Care Administration or Project Management.
* 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.
* Clinical leadership and management experience focused in serving the children, pregnant women, chronically ill, low income and/or populations with special needs.
* Master’s degree in Nursing or other Health Sciences.
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
Expertise Network Management / Provider Relations Job Type Full-Time Regular Location OK – Oklahoma City