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

Health Care Service Corporation - Tulsa, OK

Full-time - Manager

Onsite - Tulsa, OK

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, and ensuring that staff meet or exceed departmental goals. The manager will implement processes and monitor results to ensure effective customer service and compliance with account contracts, while collaborating across the organization to deliver services to customers.

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.

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 with direct reports in a managed care role.
• 2 years of clinical experience with direct care to consumers 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 to executive management and/or clients.
• Strong interpersonal and problem-solving skills.
• Presentation skills to communicate effectively to 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