Compliance Specialist (4 month contracted engagement)
AssistRx
Senior Manager, Clinical Programs – Case Management
Premera Blue Cross
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteSalary
💰 $95,600 - $162,500 per year
Job Level
Senior
About the role
- Participate in the development of Clinical Program’s strategy and plan in accordance with company's mission and strategic goals, federal and state law and regulations, and accreditation standards.
- Attract, manage, and develop clinical programs teams and promote staff development to support professional growth and operational effectiveness.
- Provide timely feedback and coaching to employees to ensure continuous development to meet current and future needs of the business.
- Represent department, programs, and clinical priorities with internal executive management and key external stakeholders.
- Lead the planning of resources and systems to support implementation of Premera's clinical program strategy and operations.
- Oversee the development and ongoing measurement of operational metrics and reports.
- Coordinate work effort with Director of Clinical Programs and colleagues of multiple teams to achieve organizational efficiency and effectiveness.
- Collect, analyze, maintain, and report data on high-risk members, contractual requirements, performance guarantees, outcome measures, resource utilization, and operational metrics.
- Act as the liaison to third party organizations that support Premera's Clinical Program activities ensuring integration between programs.
- Lead and maintain a culture of continuous improvement that positively contributes to the achievement of Premera's goals.
- Lend clinical and business expertise to support business needs.
- Develop and manage department budget(s).
- Lead, support, or participate on special projects, committees or task forces as assigned.
Requirements
- Bachelor's Degree in a business or healthcare related field or (4) years of experience in one of those areas. (Required)
- Bachelor’s Degree in nursing or Master’s Degree in behavioral health services preferred.
- Current Washington or Multistate/Compact licensed registered nurse, or licensed mental health professional. (Required)
- (7) years of health plan industry experience or business/operational experience. (Required)
- (5) years of progressive management experience including experience managing multifunctional teams in multiple locations. (Required)
- Certified in CCM (Certified Case Management) or obtain certification within 24 months of date of hire. (Required)
- Experience managing Clinical Program (Case Management) teams is preferred.
- Advanced degree e.g., MBA, MHA, or other Master's Degree preferred.
- Experience with Blue Cross and/or Blue Shield plans.
- Experience in Continuous Process Improvement (e.g., Lean or Six Sigma).
- Knowledge of federal and state regulatory or accreditation requirements (e.g., HIPAA, NCQA).
- Solid background and understanding of health care services and management.
