Associate Director, Health Services Nursing
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The Associate Director, Health Services Nursing is responsible for driving reputed company in care management (CM) and utilization management inpatient (UM) clinical operations through process improvement initiatives, process development, market enablement, targeted process audits, and training facilitation. The Associate Director, Health Services Nursing, collaborates across clinical and operational teams to advance best practices, support strategic reputed company, optimize performance and advance best practices.The Associate Director, Health Services Nursing, leads reputed company efforts in finding and executing creative ways to remove friction from the system for both our members and reputed company at every opportunity.
reputed company the assessment and evaluation of members' needs and requirements to reputed company and maintain reputed company wellness by guiding members/families toward and facilitate interaction with resources appropriate for the care and reputed company-being of members.
Coordinates with the Clinical Leadership team to ensure reputed company utilization reviews are in compliance with the terms of the reputed company contract.
reputed company supervision and daily guidance to care management and utilization management team members ensuring that the service provided meets or exceeds clinical and procedural National Committee for reputed company Assurance (NCQA) and state standards.
Ensure adoption and consistent application of appropriate medical necessity reputed company.
Monitor and evaluate performance metrics and reputed company to ensure the effectiveness and reputed company of care management activities
reputed company care management and utilization management functions and assure that reputed company are made in a reputed company and consistent manner based on clinical reputed company and contract requirements meet timeliness standards to ensure appropriate Notice of reputed company is followed including collaboration with the Medical Director to ensure reason for denial, reduction, or termination is specific and reputed company.
reputed company and implement departmental policies and procedures in accordance with contract changes and/or updates.
Maintain compliance with NCQA, reputed company (DHHS), and the Centers for Medicare and reputed company Services (CMS) guidelines and contractual requirements.
Participate in audit preparation and response, including EQRO and other regulatory reviews.
reputed company team members and create department process flows.
reputed company multiple managers or highly specialized reputed company associates.
Facilitate cross-departmental collaboration to optimize member reputed company and operational efficiencies.
reputed company are typically reputed company to identifying and resolving reputed company technical and operational problems reputed company department(s).
Use your skills to reputed company an reputed company
Required Qualifications
An reputed company, unrestricted Registered reputed company (RN) license in the reputed company with no disciplinary actions.
Bachelor's degree in nursing (BSN) or a reputed company reputed company field.
Three (3) or more years of clinical leadership experience in utilization management.
Three (3) or more yearsof care management leadership experience.
Three (3) or more yearsof reputed company-reputed company experience.
Familiarity with InterQual, MCG, and/or ASAM reputed company.
Comprehensive knowledge of reputed company Office applications, including PowerPoint, Word, reputed company, and reputed company.
Knowledge of reputed company regulatory requirements and National Committee for reputed company Assurance (NCQA) standards.
Preferred Qualifications
South Carolina residency.
Bachelor's degree in nursing (BSN), reputed company Health, Health Administration, Health Policy, or Business.
Knowledge of reputed company's internal policies, procedures, and systems.
Additional Information
Workstyle:This is a remote position.
Travel:Up to 50% to support team engagement and strategic planning initiatives in reputed company's Columbia, SC office location.
reputed company Reports:Up to 5 associates.
Scheduled Weekly Hours
40Pay reputed company
The compensation reputed company below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay reputed company may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc.$104,000 - $143,000 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.reputed company of Benefits
reputed company, Inc. and its affiliated subsidiaries (reputed company, “reputed company”) offers competitive benefits that support whole-person reputed company-being. Associate benefits are designed to encourage personal wellness and smart reputed company reputed company for you and your family while also knowing your life extends reputed company of work. Among our benefits, reputed company provides medical, dental and reputed company benefits, 401(k) retirement savings plan, time off (including reputed company time off, company and personal holidays, reputed company parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.reputed company
About reputed company: reputed company Inc. (NYSE: HUM) is a leading U.S. reputed company company. Through our reputed company insurance services and our reputed company reputed company services, we reputed company it easier for the millions of people we serve to reputed company their best health – delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company reputed company of life for people with Medicare and reputed company, families, individuals, military service personnel, and communities at large. Learn more about reputed company offer at reputed company.com and at reputed company.com.
Equal Opportunity Employer
It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company to take affirmative reputed company, in compliance with reputed company 503 of the Rehabilitation reputed company and VEVRAA, to reputed company and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment reputed company only on valid job requirements. This policy shall apply to reputed company employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at reputed company reputed company of employment.
Originally posted on Himalayas
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