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Senior Manager Network Programs

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Job Details
Job Order Number
Company Name
Health Care Service Corporation
Physical Address
Chicago, IL 60601
Job Description


Job Purpose:

This position is responsible for managing the functions of delegated utilization, case, and disease management oversight, physician quality oversight, and accreditation for commercial, exchange, and government HMO networks. Manages a professional nursing staff engaged in quality improvement activities and cost containment initiatives. Manages non-clinical staff engaged in monitoring of network provider offices and chart review. Manages the NCQA and URAC accreditation activities and ensures compliance with standards.

Required Job Qualifications:

  • Bachelor Degree and 5 years in Health Care Setting.
  • Registered Nurse with 5 years of clinical experience to the consumer.
  • 3 years leadership, supervisory, or management experience.
  • Experience in Case Management, Utilization Management and Disease Management.
  • Knowledge of regulatory and accreditation requirements and standards (NCQA,
  • Experience in managing delegated oversight programs.
  • Knowledge of quality management, utilization management, and medical practices.
  • Verbal and written communication skills.
  • Proficient in Microsoft Office (Word, Excel, PowerPoint)

Preferred Job Qualifications:

  • Certification in UM, CM or DM.
  • Experience in developing or implementing managed care quality improvement programs.
  • Experience participating in or leading NCQA Surveys.
  • Experience in Government Programs (Medicare, Medicare Advantage, Medicaid).
  • CA

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.

BCBSTX complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

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