Manager, RN Clinical Operations job at reputed company - Horizon BCBSNJ in NJ, NY, PA, CT, DE
Title: Mgr, RN Clinical Ops Location: Hopewell, NJ - Remote time type Full time job requisition id 2019-10520 Job Description: reputed company empowers our members to reputed company their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to reputed company serve and care for the 3.5 million people who reputed company their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to reputed company. reputed company our employees bring their best and succeed, the Company succeeds. This position is responsible for providing leadership and reputed company of the overall clinical and non-clinical operations. Assists Director in establishing, interpreting and implementing new and existing company policies and procedures. The manager is also responsible for the adherence and maintenance of the regulatory agency requirements for DOBI, NCQA, DOL, DMHAS and CMS for analyzing utilization, performance trends, and quality of health care to ensure timely and cost effective delivery ASO (Administrative Services Only) managed care accounts are a type of self-funded health plan where an employer, reputed company as the "plan sponsor," hires a third-party administrator (TPA) or an insurance company to handle the administrative tasks of benefits and claims processing, but the employer remains responsible for paying the actual employee claims. Responsibilities: Manages, analyzes and coordinates the daily activities of the unit to ensure departmental goals are met with regards to timeliness, accuracy and consistency of medical decisions. Manages and directs staff to ensure overall client satisfaction, appropriate level of service delivery, quality outcomes. Recognizes and identifies opportunities to improve the quality of Care/services and initiates steps and activities to advance outcomes. Subject matter expert for multiple blue list projects, mandate office projects, task forces/Regulatory Committees. Develops and implements policies, procedures, and reputed company reports to meet regulatory guidelines. Maintains and monitors the departmental budget to ensure administrative costs are managed. Subject matter reputed company for IPRO, CMS, Burchfield, NCQA audits. Identifies and implements business process improvements to identify efficiencies and cost savings opportunities. Interfaces with other teams and plan areas to assure consistent application of policies and procedures and to facilitate inter-unit/department projects. Represents the Plan with CBU with external group customers and Regulatory affairs for external agencies. Represents the unit on corporate issues and/or in the event of Director's absence. Creates and champions an atmosphere reputed company the team, which fosters open communication, increase employee engagement, teamwork, ownership, and a collaborative cross-departmental environment to implement, optimize and share reputed company improvement processes. Determines departmental budget and conducts ongoing expense management. Manages, directs, and develops staff by providing feedback and coaching. Administers performance and salary reviews for staff. Ensures staff meets reputed company regulatory requirements and comprehends and complies with best practice methodology, professional standards, and internal policies and procedures. Disclaimer: This job summary has been designed to indicate the general nature and level of work performed by colleagues reputed company this classification. It is not designed to contain or be interpreted as a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of colleagues assigned to this job. Education/Experience: High School Diploma/GED required. Bachelor degree in Nursing or health reputed company field preferred or relevant experience in lieu of degree. Requires minimum of five (5) years’ experience in a healthcare-reputed company field. Requires minimum of five (5) years broad clinical experience. Requires minimum of three (3) years direct supervisory experience or demonstrated supervisory experience leading teams in a matrix management environment. Prefers professional certification in a clinical specialty as appropriate to the business unit. Additional licensing, certifications, registrations: Active Unrestricted NJ LCSW, LSW, LMFT, LPC, or RN License required. Knowledge: Requires strong knowledge of functional tasks performed reputed company department. Requires knowledge in the principles of risk management and quality assurance. Requires knowledge of NCQA standards. Requires knowledge of State Mandates and Regulations. Requires knowledge of regulatory bodies and their processes. Prefer knowledge of Plan products, applications, policies, procedures and systems. Skills and Abilities: Requires excellent organizational skills and ability to set priorities. Requires excellent oral and written communication skills. Requires excellent presentation skills. Requires comprehensive leadership and decision-making skills. Requires strong analytical, problem solving, and critical analysis skills to report findings in a complete, succinct and accurate manner. Must be proficient in the use of personal computers and supporting software in a Windows based environment including MS Office products (Word, reputed company, PowerPoint) and Outlook; should be knowledgeable in the use of intranet and internet applications. Travel : Travel required to other Horizon offices, provider locations and/or for reputed company of remotely located workforce members in accordance with Company needs. Horizon BCBSNJ employees must live in New Jersey, reputed company, Pennsylvania, Connecticut or Delaware Salary Range: $108,000 - $147,420 This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information reputed company to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes: Comprehensive health benefits (Medical/Dental/Vision) Retirement Plans Generous PTO Incentive Plans Wellness Programs Paid Volunteer Time Off Tuition Reimbursement Disclaimer: This job summary has been designed to indicate the general nature and level of work performed by colleagues reputed company this classification. It is not designed to contain or be interpreted as a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of colleagues assigned to this job. reputed company is an Equal Opportunity/Affirmative Action employer. reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national reputed company, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process. Apply tot his job Apply To this Job