Registered Nurse - Manager, Clinical Operations (ALBUQUERQUE/TULSA)

Health Care Service Corporation - Albuquerque, NM

Full-time - Manager

Onsite - Albuquerque, NM

Insurance Carriers and Related Activities

About the position

The Registered Nurse - Manager, Clinical Operations is responsible for supervising clinical staff involved in various clinical operations, including risk management and clinical appeals. This role includes hiring, training, performance reviews, pay administration, and ensuring that staff meet or exceed goals and initiatives. The manager will implement processes and procedures, monitor results, and ensure effective customer service while meeting account contracts. This position is based in Albuquerque, NM or Tulsa, OK and requires management experience with direct reports, as well as utilization management experience.

Responsibilities

• Supervise clinical staff involved in clinical operations such as risk management and clinical appeals.
• Hire, train, and conduct performance reviews for clinical staff.
• Administer pay and manage change within the team.
• Ensure staff meet or exceed departmental goals and initiatives.
• Implement processes and procedures to monitor results and ensure effective customer service.
• Ensure the department meets account contracts and collaborates across the organization to deliver services.

Requirements

• Registered Nurse (RN) with a current license in good standing in the state of operations (Mexico or Oklahoma).
• 4 years of clinical managed care experience.
• 2 years of supervisory experience in a managed care role with direct reports.
• 2 years of clinical experience providing direct care in medical-surgical nursing or Home Health Care.
• Knowledge of nursing practices and analytical skills.
• Experience developing and maintaining self-directed work teams.
• Proficiency in Microsoft Word, Excel, PowerPoint, and databases.
• Experience developing recommendations for executive management and/or clients.
• Strong interpersonal and problem-solving skills.
• Presentation skills to communicate effectively with internal and external customers.
• Knowledge of UM Metrics, HEDIS, NCQA, and URAC.

Nice-to-haves

• Clinical Certification in the approved URAC certification listing.
• Bachelor or advanced degree.

Benefits

• Annual Incentive Bonus plan
• Relocation assistance (not provided for this position)