Blue Cross and Blue Shield of Illinois, Montana, N Sr Manager Government Programs Clinical Ops in Downers Grove, Illinois


BASIC FUNCTION:This position is responsible for developing and implementing Managed Care programs and strategies for Government Programs Clinical Operations; establishing cost-containment goals and objectives for the department along with policies, practices and procedures needed to meet those objectives; and for representing the company and division before outside customers and consultants. JOB REQUIREMENTS:* Registered Nurse (RN) with unrestricted, current license in the state of operations.* Knowledge of medical terminology and procedures.* 5 years of health insurance experience in Utilization Management, Case Management or Quality Management.* 5 years of management experience.* 2 years clinical nursing experience.* Knowledge of accrediting body requirements (ie; NCQA or URAC). * Experience with traditional Medicare, or Dual Eligible, or Medicaid claims payment rules and their impact on care management processes.

Location: IL - Downers Grove

Activation Date: Monday, March 12, 2018

Expiration Date: Sunday, April 1, 2018

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