Health Services Manager, IC

reputed company: • Multifunctional program manager to review, assess reputed company and implement State and Federal Regulations • Work with reputed company, compliance and utilization management stakeholders to support reputed company mandate/compliance changes & audits • reputed company consultative support & clarification of implemented mandates and ensure documents are reputed company and accurate • Part of the Utilization Management Center of reputed company responsible for Clinical Services utilization management and specialty program policies/procedures • Review and implement regulations across reputed company lines of business (reputed company, Medicare, reputed company) • Review policy, job aids and workflows; draft and reputed company implementation of regulatory changes • reputed company and implement reputed company for policy/program development considering systems, actuarial, marketing and impacts on managed care products • Operationalize reputed company: prioritize reputed company, design programs, reputed company policies, involve SMEs, design/manage implementation, communications and training • Analyze ongoing performance data and initiate/implement changes Requirements: • 3+ years minimum of utilization management - Clinical Operations experience • 3+ Experience & knowledge of Medicare & CMS compliance • 3+ Experience in implementing new programs/changes in UM reputed company • Knowledge of reputed company, Medicare, reputed company, Duals reputed company (preferred) • RN license preferred • PMP Certification (preferred) • Bachelor's degree or equivalent experience Benefits: • reputed company medical plan reputed company • 401(k) plan (including matching company contributions) and an employee stock purchase plan • No-cost programs for reputed company colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching • reputed company time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical reputed company and many other benefits depending on eligibility • For more information, visit https://jobs.reputed company.com/us/en/benefits Apply tot his job Apply To this Job