Strategic Director, Government Programs Clinical Operations

Enterprise HCM; Downers Grove (IL); Hybrid; USD 121,000 - 225,000; Full time

Job summary

HCSC is seeking a senior leader to direct change in processes and project integration for Government Programs Clinical Operations, spanning Medicare Advantage, Dual Eligibles, and Medicaid products.

You will optimize clinical reviews across Medical Management, Operations, Marketing/Sales and Medical, ensure accreditation and government regulatory compliance, and drive cost of care initiatives, quality analytics, and performance improvement.

Qualifications

• Bachelor degree OR clinical licensure (RN, LISW, LMSW, LPC, LCPC, LCSW) with current, unrestricted license.
• 4 years of management experience.
• 8 years in managed care operations, care management, quality of care or government health programs.
• Knowledge of Medicaid programs, claims payments and their impact on care management processes.
• Knowledge of State and Federal Medicaid regulations.
• Experience developing business requirements and reporting.
• Project management experience in medical processes.

Responsibilities

• Direct change in processes and integration of projects for Government Programs Clinical Operations.
• Optimize the clinical review process across Operations, Marketing/Sales and Medical departments.
• Ensure compliance with accreditation standards and government regulations.
• Lead cost of care initiatives and clinical management tools.
• Oversee triage and reporting of high dollar claims.
• Direct quality and performance analysis and customer service standards.
• Manage staff toward meeting goals and drive performance improvements.

Skills

Analytical skills

Verbal and written communication

Collaborative leadership

Travel readiness

Education

Bachelor's degree or clinical licensure

Job description

HCSC is seeking a senior leader to direct change in processes and project integration for Government Programs Clinical Operations, spanning Medicare Advantage, Dual Eligibles, and Medicaid products.

You will optimize clinical reviews across Medical Management, Operations, Marketing/Sales and Medical, ensure accreditation and government regulatory compliance, and drive cost of care initiatives, quality analytics, and performance improvement.