Mgr Health Services

Location: Albuquerque, NMEducation Required: Bachelors DegreeExperience Required: At least 4 yearsPosition Description:BASIC FUNCTION:This position is responsible for leading and managing the development, implementation, strategic day-to-day administration of Health Services operations in all aspects of utilization management (UM), including preauthorization, prospective, concurrent, and retrospective review. Establish and lead team efforts, communications, protocols and procedures for managed care activities ensuring the cost effectiveness of health care delivery by an ongoing interface with HCSC counterparts, Quality Management and Improvement Department, Network, SSD, Membership, Marketing/Sales, and Publications. Meet and exceed internal and external customer service expectations.JOB REQUIREMENTS:1) Registered Nurse (RN) with Bachelor Degree and 4 years clinical experience or combination of education and experience; 2) 2 years supervisory experience in a utilization management role; 3) 4 years of medical-surgical nursing and Home Health Care background; 4) Sound nursing knowledge, analytical and interpersonal skills; 5) Leadership or supervisory experience; 6) Ability to develop and maintain self-directed work teams; 7) PC experience to include Microsoft Word, Excel, PowerPoint; 8) Analytical skills and the ability to make appropriate recommendations to the executive management, Medical Directors, to other departments and to specific clients; 9) Interpersonal and problem solving skills; 10) Presentation skills and ability to present information clearly, concisely, and in a positive manner to internal and external customers; 11) Knowledge of all operational areas and systems, and the manner in which Health Services activities interrelate with and are impacted by them; 12) Knowledge of UM Metrics, HEDIS, NCQA and URAC.PREFERRED JOB REQUIREMENTS:1) Certification in UM and CM; advanced degree..