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Clinical Process Improv Spec

Company: HCSC
Location: Richardson
Posted on: June 8, 2021

Job Description:

Job ID: WS-1042211

Description:

This role must be located in either Downers Grove, Chicago or the Richardson, TX local areas. This will be considered a hybrid role for work space once offices are re-opened.

BASIC FUNCTION:

This position is responsible for developing and evaluating clinical business processes to support the cost of care, quality, compliance and financial performance strategy for the divisional/enterprise care management operations. Responsible for providing independent, objective evaluation and consultative services that enhance business performance, minimize risk and optimize care management programs/services/interventions. Collaborate with clinical operations management, EHCM Learning and Development, and Culture and Engagement teams in identification and implementation of best cost of care management practices. Develop methodologies and tools to monitor performance and prepare Executive Summaries.

JOB REQUIREMENTS:

  • Registered Nurse (RN) with current, unrestricted clinical license to practice in state of operations.
  • 2 years clinical experience.
  • 1 year clinical auditing or managed care experience.
  • Knowledge of managed care operations.
  • Analytical skills to effectively identify improvement opportunities and root cause.
  • Verbal and written communication skills to work across the division, collaborate with management, develop executive summaries.
  • PC experience utilizing Microsoft Office software.

PREFERRED JOB REQUIREMENTS:

  • Experience in accreditation and Quality standards under URAC, NCQA and JCAHO and applying those standards in an operational space.
  • Bachelor Degree in Nursing or Health Administration or in the healthcare field.
  • Managed care experience with working knowledge of managed care and UM/CM policies and practices.
  • Certified Professional Health Care Quality (CPHQ Certification).
  • Six Sigma training or certification.
  • Ability to travel including overnight stays, as needed.
  • CA

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

Requirements:

Expertise Audit, Nursing Job Type Full-Time Regular Location IL - Downers Grove, TX - Dallas, TX - Richardson, IL - Chicago

Keywords: HCSC, Richardson , Clinical Process Improv Spec, Other , Richardson, Texas

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