Manager Clinical Ops and Support- CHOICES

BCBST is seeking a passionate healthcare leader looking to make an impact within the CHOICES program as a Field-Based Clinical Operations Model. 

In this position, you would play a pivotal role in ensuring an integrated model of care throughout the CHOICES program.

In this role, you will:

• Manage the field-based clinical operations for care coordination, interfacing with TennCare, network providers, Medical Directors, and other departments.
• Provide oversight and monitor cost, utilization, and quality of care trends, identifying opportunities to reduce administrative costs and ensuring HCBS services are allocated appropriately while maintaining accreditation standards.
• Oversee all care coordination staff across the state, including 156 care coordinators, 12 supervisors, and 4 regional managers.

You will be a great match for this role if in addition to the qualifications, you have experience leading large teams and managing large-scale initiatives.

Job Responsibilities

• Collaborates on internal policy and procedure development, implementation and revisions to meet state and regulatory compliance standards relating to care coordination services, utilization management, continuum of care, and transitional/discharge planning initiatives
• Build and maintain effective working relationships with internal and external business partners, working closely to support members needs
• Manages the field-based clinical operations for care coordination; interfaces and represents BlueCare with TennCare, network providers, Medical Directors, and other departments to ensure an integrated model of care.
• Monitors cost, utilization, and quality of care trends; identifies opportunities to reduce costs or improve quality of care and collaborates with quality improvement area to implement and manage clinical quality improvement strategies, and maintain accreditation standards.
• 40-60 % travel required.

Job Qualifications

Licensure:

• Registered nurse with an active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Act; or Masters prepared licensed Social Worker

Experience

• 5 years - Proven leadership/management experience
• 5 years - Experience in clinical operations, quality improvement/assurance, or highly technical process improvements, and/or business process engineering required.
• 3 years - Experience providing care coordination to persons receiving long-term care and/or home and community based services required

Skills/ Certifications

• Ability to conduct root cause analysis, plan, organize and coordinate multiple projects
• Strong interpersonal and organizational skills
• Strong strategic planning, analytical and decision-making skills
• Ability to speak in public and conduct effective presentations.

Supervision of 6 Regional CHOICE Managers

Number of Openings Available:

Worker Type:

Company:

Applying for this job indicates your acknowledgement and understanding of the following statements:

BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

Tobacco-Free Hiring Statement

To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits. A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco/nicotine test.  An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotine  and/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results.

Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW.