Blue Cross and Blue Shield of Illinois, Montana, N Clinical Process Improvement Specialist in Richardson, Texas



BASIC FUNCTION:This position is responsible for developing and evaluating clinical business processes to support the cost of care, quality, compliance and financial performance strategy for the divisional/enterprise care management operations. Responsible for providing independent, objective evaluation and consultative services that enhance business performance, minimize risk and optimize care management programs/services/interventions. Collaborate with clinical operations management, EHCM Learning and Development, and Culture and Engagement teams in identification and implementation of best cost of care management practices. Develop methodologies and tools to monitor performance and prepare Executive Summaries. JOB REQUIREMENTS:* Registered Nurse (RN) with current, unrestricted clinical license to practice in state of operations.* 2 years clinical experience.* 1 year clinical auditing or managed care experience.* Knowledge of managed care operations.* Analytical skills to effectively identify improvement opportunities and root cause.* Verbal and written communication skills to work across the division, collaborate with management, develop executive summaries.* PC experience utilizing Microsoft Office software.

PREFERRED JOB REQUIREMENTS:* Bachelor Degree in Nursing or Health Administration or in the healthcare field.* Managed care experience with working knowledge of managed care and UM/CM policies and practices. * Certified Professional Health Care Quality (CPHQ Certification). * Six Sigma training or certification. * Ability to travel including overnight stays, as needed.

Location: TX - Richardson

Activation Date: Tuesday, July 10, 2018

Expiration Date: Saturday, August 11, 2018

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