Sr. Manager, Service Coordination

University Health; San Antonio (TX); On-site; USD 90,000 - 120,000; Full time

Job summary

University Health is seeking an experienced manager to oversee the Community First Health Plans STAR Kids clinical activities and deliverables while ensuring compliance with regulatory and accreditation standards. You will guide PHM staff administratively and clinically, optimizing resource use within the STAR Kids benefit schedule.

The role emphasizes developing compliant policies/procedures and implementing projects aligned with system goals, with prior HMO/managed care experience preferred.

Qualifications

• Bachelor's degree in health education, nursing, social services, or healthcare-related field required.
• Master's degree preferred.
• Two years of managerial experience required.
• Experience in an HMO or managed care setting preferred.
• Thorough understanding of NCQA standards and HHSC regulations.

Responsibilities

• Provide oversight and management of STAR Kids clinical activities and deliverables to ensure contractual, regulatory, and accreditation standards are met.
• Provide administrative and clinical guidance to Population Health Management staff.
• Develop policies and procedures to assure compliance with Medicaid and other required agencies.

Skills

Team management

Policy development

Healthcare operations

NCQA knowledge

Education

Bachelor's degree in health education, nursing, social services, or healthcare-related field

Master's degree preferred

Tools

Information systems

Job description

Provide oversight and management of the Community First Health Plans (CFHP) STAR Kids clinical activities and deliverables related to service coordination assuring all contractual, regulatory and accreditation standards are met. Provide administrative and clinical guidance to all Population Health Management (PHM) STAR Kids clinical and administrative staff. Oversee the efficient utilization of resources within the schedule of benefits for the STAR Kids program.Implements projects and activities to attain goals established by the Health System. Develops policies and procedures to assure compliance with Medicaid or any other agency that UHS is contractually required to follow. Promotes the Health System’s mission, purpose, goals, objectives and commitment to service excellence.

EDUCATION/EXPERIENCE

Graduation from an accredited college or university with a bachelor's degree in health education, nursing, social services, or -a healthcare related field is required. Master’s degree preferred.An understanding of long-term support services and service coordination for a disabled population is required. Familiarity with information and computer systems is required.Must exhibit thorough understanding of NCQA standards and HHSC regulations. Minimum of two years managerial experience is required. Experience in an HMO setting or managed care is required.

LICENSURE/ CERTIFICATIONS

If a Registered Nurse or Social Worker must be licensed in the State of Texas.