Health Plan Clinical Operations Manager (Peri-Service)

Location: Maryland - Halethorpe
Duration: Full Time
Job ID: 830595 (21987807)
Category: Managed Care RN Job
Company: ProEnlist
Contact: April Estes    Call: 7204392609
Job Posted: 01/26/21

Health Plan Clinical Operations Manager (Peri-Service) - 830595 (21987807)

The Company: 
Recognized as one of America's leading health care providers and not-for-profit health plans. Founded in 1945, their mission is to provide high-quality, affordable health care services and to improve the health of their members and the communities they serve. Currently serving 11.8 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Their expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the art care delivery and world-class chronic disease management.


Position Overview: 
To coordinate the delivery of quality patient care to facilitate member satisfaction with the care experience.


Main Responsibilities: 

  • Manages clinical operations, including staffing schedules, phone access to the health care team, and patient flow.
  • Is responsible for all appropriate documentation and reporting requirements, such as QA reports, performance evaluations, time sheets, and budget variance reports.
  • Ensures the appropriate level and mix of staff and effective staff utilization to meet staffing and workload requirements and support the delivery of quality patient care and services, within budgetary guidelines.
  • Establishes performance goals and provides counseling, coaching, feedback, recognition, training and development to staff.
  • Manages quality improvement initiatives for areas of responsibility and ensures compliance with HEDIS indicators and other mandated standards.


Required Qualifications:  

  • Minimum five (5) years of current clinical experience plus two (2) years of supervisory experience required.
  • Bachelor's degree required, OR four (4) years of experience in a directly related field.
  • High School Diploma or General Education Development (GED) required.
  • Current Registered Nurse license in Maryland (or compact state license) required.
  • Current American Heart Association BLS, ACLS and PALS required.
  • Demonstrated clinical and managerial competence appropriate to area(s) of responsibility; familiarity with all pertinent laws, regulations, and standards of nursing practice; demonstrated competence with financial management principles and standard software applications in a Windows environment required.


Preferred Qualifications:

  • CNOR Preferred
  • Operating Room Experience


Benefits: 

  • As an employee, you are eligible for benefits according to your full-time/part-time status and the number of hours scheduled to work per week. Benefits may vary based on your region, position, scheduled hours, and representation by collective bargaining or employee groups, but generally include:
  • generous vacation, holiday, and sick leave
  • medical care (including prescriptions), vision, mental health, & dental care
  • disability and life insurance coverage
  • educational opportunities and tuition reimbursement
  • employee assistance programs
  • health care, dependent care, and transit spending account options
  • retirement plans