Director Health Services

Profile

Description

The Director, Health Services utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Director, Health Services requires an in-depth understanding of how organization capabilities interrelate across the function or segment.

Responsibilities

The Director, Health Services uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Decisions are typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves performance. Provides input into functions strategy.

Required Qualifications


Graduate from an accredited School of Nursing, with at least 5 years of clinical experience.
Current, valid, and active license to practice as a Registered Nurse in the state of employment
8 or more years of technical experience, to include a combination of Utilization Management, and Case Management
Knowledgeable in utilization review, medical terminology, appropriate levels of care, treatment, modalities, statues, and healthcare delivery models
5 or more years of leadership experience
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Intermediate to advanced computer skills and experience with Microsoft Office specifically Power Point, Word, Excel and Outlook.
Previous experience with electronic case note documentation and experience with documenting in multiple computer applications/systems.


Preferred Qualifications


Master's Degree
Experience working with Medicare populations


Additional Information

Scheduled Weekly Hours

40

Company info

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