Operations Manager - HealthSpring (Nashville, TN)
Cigna - Nashville, TN

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Job Description Directs operations activities for a significant functional or multi-functional area of the organization. Ensures compliance with the organization's policies and government regulations. Directs the review of operations systems and procedures, and recommends improvements to increase efficiency..

Responsibilities

Responsible for directing one or more health services areas, including case management, medical review, utilization review, quality management, audit, coding, P4Q, and health education programs. Provides strategic planning, project management, budget planning, decision making, and direction of a quality, cost effective delivery system providing health services to members.

Responsible for the operation-development, implementation and management of the Health Services Integrity Unit. Additionally responsible for coordinating health services policies and procedures development, revisions, and application monitoring for health services. May monitor and coordinate activities related to grievances, appeals, heath risk assessment, disease management, or life enhancement functions. Responsible for compliance with company, state, and federal policies, procedures, and regulations. May provide training to staff, manage individual investigation, and oversee application of NCQA and other processes.. Requirements

Qualifications

Minimum: Bachelor’s degree. At least seven years experience in utilization, case management, or quality management. Broad knowledge of managed care concepts. Five or more years’ management experience. Strong analytical, problems solving, communication, presentation, public speaking, attention to detail and time management skills. Demonstrated ability to work in a collaborative environment with many other functional areas. Prior experience managing a budget. Ability to be agile and balance competing priorities within timeframes and in accordance with rules, regulations and applicable policies and procedures. Previous experience managing others and working with team members at all levels of an organization.

Preferred: Master’s Degree. Active Registered Nurse (RN) license, Licensed Physical Therapist (LPT), Licensed Respiratory Therapist (LRT), Licensed Social Worker (LSW), Registered Dietitian (RD), or Psychologist..

CIGNA - 23 months ago - save job - copy to clipboard
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With a significant position in the US health insurance market, CIGNA covers some 11.5 million Americans with its various medical plans. The...