at Health Care Service Corporation in Chicago, Illinois, United States
Job Description
At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.
Come join us and be part of a purpose driven company who is invested in your future!
Job Summary
This position is responsible for managing all clinical and non-clinical operations through a joint clinical model, directing and controlling all resources and staff to execute and deliver on the health advocacy solutions, providing leadership in the management of the clinical areas; representing the department to internal personnel and external key stakeholders such as providers, regulatory bodies, members and customers, while managing the operations for clinical care programs to support effective utilization, advocacy and support of organizational strategies. Responsible for the performance, quality and cost effectiveness and execution of specific clinical care and operational programs. The position will be responsible for developing and maintaining matrixed relationships with key stakeholders. Specific functions include primary oversight of development and implementation of health advocacy solutions care management components, clinical oversight of outcome measures and working to ensure the compliance of health care management programs with specific regulatory and accreditation requirements. The position is responsible for 1) the overall success of health advocacy solutions program delivery, ensuring compliance to all government and regulatory requirements, group customer mandates and requirements, HCSC customer service organizational goals, and process improvements within customer service areas; 2) collaborates with divisional chief medical officers, plan leads, divisional vice presidents, vice presidents, and other key stakeholders in the design and successful implementation of enhanced and evolving clinical programs for the health advocacy solutions market.
Required Job Qualifications:
* Clinical license (RN, LPC, LMSW, LISW) or Bachelor degree in health or business field.
* 12 years managed care experience in a health insurance environment.
* 10 years people management experience, experience at a director level managing at least 100 FTEs and the responsibility for associated budget.
* In depth knowledge of all aspects of managed care medical management programs.
* Experience in the creation, development and implementation of process improvement and instilling that focus in a team.
* Experience developing high-level strategies; strategic thinker and implementer.
* Project Management experience applying industry methodologies and practices.
* Computer proficiency including clinical databases and medical information systems to analyze and use data to report and improve results.
* Expertise in developing presentations and executive summaries and presenting to executive staff.
* Negotiation and influence skills.
* Clear and concise verbal and written communication skills.
Preferred Job Qualifications:
* Advanced degree in business, public health, administration or other business field.
* Clinical certification.
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
HCSC Employment Statement:
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.
