Manager, Clinical Managed Care Programs

  • 16945 Northchase Dr, Houston, TX 77060, USA
  • Employees can work remotely
  • Full-time

Company Description

HealthHelp - A WNS Company (www.HealthHelp.com), is the leader in the field of healthcare utilization & care management. We have gained this position by actively working to change out-of-date practices with a collaborative, non-denial based approach. Our methodology helps payors achieve a higher return on investment, gives providers education programs that better inform physicians, and ensures quality and safety for the patients needing treatment.

HealthHelp’s innovative approach and strong IT capability in specialty benefits management means that staff will move healthcare forward when provided with evidence-based solutions and second opinions. HealthHelp's staff is comprised of healthcare professionals who make a difference every day. HealthHelp has a desire to fill their company with talented and innovative people who want a career path filled with success and personal growth.

Our specialty benefits management services are broad and include, Cardiology, Oncology, Radiology, Radiation Therapy, Sleep Care, and Musculoskeletal Care. HealthHelp has two locations in Houston, one a corporate office and the second a state-of-the art contact center. HealthHelp is also proud to have another such contact center in Albany, New York.

WNS Global Services Inc. (NYSE: WNS) is a global Business Process Management (BPM) leader. WNS offers business value to 400+global clients by combining operational excellence with deep domain expertise in key industry verticals, including Banking and Financial Services, Consulting and Professional Services, Healthcare, Insurance, Manufacturing, Retail and Consumer Packaged Goods, Shipping and Logistics, Telecommunications, Travel and Utilities. Globally, the group’s over 44,000+ Professionals serve across 60 delivery centers in 16 countries worldwide.

Job Description

  • Assist in translation program savings methodologies and clinical guidelines into Consult protocols and decision pathways that ensure program goals are successful
  • Responsible for capturing data elements necessary to ensure quality and safety standards are adhered to
  • Ensuring future enhancements can be measured in meaningful ways
  • Gathers end user requirements, conducts needs assessments, and develops functional specifications to ensure that clinical information systems support client initiatives.
  • Develops and provides descriptive and analytic data to further understand outcomes and utilization for training and observations for optimal effectiveness and performance
  • Collaborates with leadership team to facilitate development of metric and process for data collection to support timely and efficient reviews
  • Identifies trends and able to provide recommendations for communication on concerns in workflows and educational needs to ensure challenges are addressed
  • Partners with the cross-functional teams to ensure routine data collection to compile for database entry and prepares appropriate reports
  • Ensures understanding of the routine required reporting and associated regulations to support manager s timely knowledge and required follow through for evaluation of process improvement and required presentations.
  • Assess rules and guidelines to improve impact and program efficiency
  • Assess and compare our programs to our competitors to assure our programs are performing competitively

Qualifications

  • Current license as an LVN, LPN, or RN
  • Managed Care experience required
  • Bachelor’s Degree in Nursing or Healthcare Related Field or equivalent experience
  • 2 to 3 years of clinical experience
  • Experienced user of excel; Microsoft office products; knowledge of Tableau and SQL is a plus
  • Minimum of 3 years’ experience analyzing healthcare data

Additional Information

All your information will be kept confidential according to EEO guidelines.

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