Job Location |
Geographic Location: Bedford, Texas 76022
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| Health Services Manager |
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Job Code: 5718
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Health Services Manager, plans, organizes, and manages the case management, medical review, utilization review, appeal management, audit, and/or health education programs. Analyzes utilization trends. Develops and implements action plans to improve utilization and quality.
Facility Description:
Health Services Manager
Based on the extensive growth of our corporation, we are looking to add a number of accomplished professionals to join our growing Leadership team that will be servicing our members in the Rio Grande Valley area of South Texas. These positions will be based in Laredo, McAllen and Bedford. We are looking for roll up your sleeves working Managers who are looking to be Servant Leaders to their staff and have a real focus on providing quality member services every day. . We are able to offer opportunities for professional advancement - which is a driver of our success.
Join a Dynamic Organization that offers Excellent Career Growth and Opportunity. Full Benefit Package, Competitive Salary, + Bonus.
HealthSpring is one of the countrys largest and fastest-growing coordinated care plans whose primary focus is Medicare Advantage plans. Health Spring currently owns and operates Medicare Advantage plans in Alabama, Delaware, Florida, Georgia, Illinois, Maryland, Mississippi, New Jersey, Pennsylvania, Tennessee, Texas, and Washington, D.C., as well as a national stand-alone prescription drug plan. Our concentration on this market has allowed us to develop a unique approach to healthcare coverage for Medicare beneficiaries.
HealthSpring is a financially stable and fundamentally sound corporation experiencing tremendous success based on our corporate model as well as our delivery methods for the patient populations in which we service. The key reason for our success are based on our core principles of ; Focus on Medicare Advantage, Local Roots - with a local market presence to allow us the flexibility to respond to the needs of our individual service areas, Coordinated Care and Revolutionary Physician Engagement Model
HealthSpring is dedicated to improving the health of the communities we serve by delivering the highest quality and greatest value in healthcare benefits and services.
Job Requirements:
Required Skills
Responsible for assisting in the development, implementation and management of health services functions and in achieving department goals and objectives. Provides guidance and supervision to staff. May handle grievance and/or appeal process. May coordinate and manage utilization review function ensuring accurate and timely prior authorizations, concurrent and retrospective review activity. May be responsible for increasing patient compliance through education to optimize heath and minimize complications and exacerbation. Responsible for process improvement implementation, quality initiatives, and daily operations of the department. Supports leadership in the update of policies and procedures that are compliant with CMS and NCQA/URAC/CMSA requirements. May audit and must comply with corporate, federal, and state policies, procedures, and confidentiality standards. Conducts analysis on department statistics and creates reports on the findings. May act as a liaison with internal departments, outside entities, including physicians, hospitals, health care vendors, social service agencies, member advocates, and regulatory agencies.
Required Experience
Bachelors degree in nursing or relevant area of study. Active Registered Nurse (RN) license, Licensed Physical Therapist (LPT), Licensed Respiratory Therapist (LRT), Licensed Social Worker (LSW), Registered Dietitian (RD), or Psychologist. At least three years experience in managed care. For Clinical positions, at least four years of clinical experience. Previous leadership or management experience. Bilingual English/Spanish.
HealthSpring, Inc. is an EOE/AA employer.
Relocation:
Yes
Benefits:
Employees become eligible for benefits in accordance with the following schedule1:
Medical, Dental, Vision, Flexible Spending Accounts:
- First of the month on or next following the employees first day of work.
Basic Life and AD&D:
- First day of work.
Voluntary Life and AD&D (including voluntary coverage for spouse and children):
- First day coverage is approved.
Short-Term Disability:
- First of the month on or next following the completion of one year of service.
Long-Term Disability:
- First of the month on or next following the completion of three months of service.
401(k):
- Following 30 days of service |
Job Details |
Date Posted: 01/06/2012
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Position Type: Professional
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Job Status: Full Time
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Specialty Type: Administrative Medicine |
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Employment Setting: Not Specified
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