Nurse - Director Health Management Commercial – Saint Paul

Summary:

This position is responsible for the strategy, design / development, and operations for Integrated Health management for national, commercial, and CCS Taft Hartley lines of business. This includes directing all care management activities relative to medical, surgical, and behavioral health care to create a continuum of care for our members. The Director is responsible for leading, guiding and motivating the Integrated Health Management (IHM) department staff. The incumbent works collaboratively with other leaders and executive management in the organization to assure that business strategies and financial objectives are delivered.


Accountabilities:

1. Designs, develops and leads the implementation of case/disease/utilization management operations to meet members/providers/account needs and expectations.
2. Designs and implements a resource and capacity management strategy to maximize efficiencies in the IHM delivery environment.
3. Collaborates with strategic partners and external customers to develop and implement integrated health management strategies
4. Directs the development and execution of case/disease/utilization management programs that directly enhance Blue Cross? community and account relationships. Actively seeks out opportunities to demonstrate Blue Cross? commitment to the communities and accounts that we serve.
5. Assures regulatory compliance with state and federal agencies on health management activities.
6. Coaches and develops staff to create a positive work environment that ensures the retention of qualified professional staff to provide superior service to our members and providers.
7. Acts as a knowledge expert resource for other areas of the company. Participates in design of new products, operations improvements, systems enhancements, etc.
8. Develops departmental budgets and assures that operations are managed within those parameters.
9. Manages the department including interviewing and hiring employees following required EEO and Affirmative Action guidelines and ensures employees receive the proper training. Conducts performance evaluation, and is responsible for managing employees, including skill and career development, policy administration, discipline, employee relations and cost control.


Required Qualifications:

1. Bachelor's degree (or higher) in health care related field
2. MN licensure as an RN
3. 8 years experience with increasing responsibility in management required.
4. Must have a solid understanding of managed care, the health care industry and state/federal health insurance regulations.
5. Must have the business expertise, financial acumen and interpersonal skills to collaborate and effectively work through a complex organization to influence change.
Demonstrated ability in developing and implementing strategic initiatives.
6. Proven ability to exercise good judgment and make independent decisions.
7. Excellent organizational and time management skills.
8. Well developed written and oral communication skills with the ability to explain complex information clearly and convincingly.
9. Working knowledge of information technology in a business environment.


Preferred Qualifications:

1. Ten years experience with increasing responsibility in management.
2. Masters Degree.



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