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

Health Care Service Corporation - Albuquerque, NM

Full-time - Mid Level

Onsite - Albuquerque, NM

Insurance Carriers and Related Activities

About the position

This position is responsible for supervising clinical staff involved in various clinical operations, including risk management and clinical appeals. The role includes hiring, training, conducting performance reviews, managing pay administration, and ensuring that staff meet or exceed their goals and initiatives. The supervisor will implement processes and procedures, monitor results, and ensure effective customer service delivery while meeting account contracts. This is a flex position based in Albuquerque, NM, or Tulsa, OK, and is not a remote position.

Responsibilities

• Supervise clinical staff involved in clinical operations such as risk management and clinical appeals.
• Hire, train, and conduct performance reviews for clinical staff.
• Manage pay administration and change management processes.
• Ensure staff meet or exceed goals and initiatives.
• Implement processes, procedures, and initiatives and monitor results.
• Ensure effective customer service delivery and compliance with account contracts.
• Collaborate across the organization to deliver services to customers.

Requirements

• Registered Nurse (RN) with a current license in good standing in New 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's or advanced degree.

Benefits

• Annual Incentive Bonus plan based on job-related skills, education, knowledge, and experience.