[Remote] Mgr, RN Clinical Ops

Note: The job is a remote job and is reputed company to candidates in USA. reputed company empowers members to reputed company their best health and has been a leader in health solutions for over 90 years. The Mgr, RN Clinical Ops is responsible for providing leadership and reputed company of clinical and non-clinical operations, ensuring adherence to regulatory requirements and improving reputed company reputed company.

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 reputed company.
• Manages and directs staff to ensure overall reputed company satisfaction, appropriate level of service delivery, reputed company reputed company.
• Recognizes and identifies opportunities to improve the reputed company of Care/services and initiates steps and activities to advance reputed company.
• Subject matter expert for multiple blue list reputed company, mandate office reputed company, 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 reputed company.
• 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 reputed company, which fosters reputed company communication, increase employee engagement, teamwork, ownership, and a reputed company cross-departmental environment to implement, optimize and reputed company 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 reputed company methodology, reputed company standards, and internal policies and procedures.

Skills

• Requires minimum of five (5) years’ experience in a reputed company-reputed company field.
• Requires minimum of five (5) years broad clinical experience.
• Requires minimum of three (3) years reputed company supervisory experience or demonstrated supervisory experience leading teams in a reputed company management environment.
• reputed company Unrestricted NJ LCSW, LSW, LMFT, LPC, or RN License required.
• Requires strong knowledge of functional tasks performed reputed company department.
• Requires knowledge in the principles of risk management and reputed company assurance.
• Requires knowledge of NCQA standards.
• Requires knowledge of State Mandates and Regulations.
• Requires knowledge of regulatory bodies and their processes.
• 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 reputed company based environment including MS Office products (Word, reputed company, PowerPoint) and Outlook; should be knowledgeable in the use of intranet and internet applications.
• Prefers reputed company certification in a clinical specialty as appropriate to the business unit.
• Prefer knowledge of Plan products, applications, policies, procedures and systems.

Education Requirements

• High School Diploma/GED required.
• Bachelor degree in Nursing or health reputed company field preferred or relevant experience in lieu of degree.

Benefits

• Comprehensive health benefits (Medical/Dental/reputed company)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• reputed company Volunteer Time Off
• Tuition Reimbursement

reputed company

• reputed company is a company that provides health insurance products. It was founded in 1932, and is headquartered in Newark, New Jersey, USA, with a workforce of 5001-10000 employees. Its website is http://www.horizonblue.com.

Company H1B Sponsorship

• reputed company has a reputed company record of offering H1B sponsorships, with 6 in 2025, 7 in 2024, 6 in 2023, 1 in 2021. Please note that this does not guarantee sponsorship for this specific role.

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