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Job Summary

This position is responsible for supporting HCSC’s Value Based Care models and relationships through participation in model/program development, clinical readiness assessments of entity and network management led joint operating committees. Role is also responsible for creating and maintaining strong working relationships with the care coordination/care management teams at the value-based entity and internally with local network management and internal clinical operations teams to provide consultative support and ensure day to day operational needs are being met. Essential functions include implementation of Provider (Medical) Group facing Initiatives necessary to support both HEDIS improvement and the CMS and State mandated Quality/Performance Improvement Projects. Activities include Analyzing base line data related to multiple provider groups’ health outcomes; determining best interventions to improve outcomes; developing and deploying interventions; monitoring performance indicators, and providing trending data analysis of each provider group’s performance and effectiveness of deployed intervention during Joint Operating Committee Meetings.

**This is a Flex Position (3 days in the office) office located in Albuquerque, NM**

Required Job Qualifications:

• Current, unrestricted license in one of the following: Registered Nurse (RN), Physician's Assistant OR MSW (Master of Social Work)/LCSW (Licensed Clinical Social Worker) or Licensed Professional Counselor (LPC) with current, unrestricted license to practice in the state of operations OR Bachelor’s degree in clinical field OR Bachelors degree with 5 years experience in managed care to include prior field-based provider responsibility.

• 5 years of experience in managed care.

• Experience designing clinical program(s).

• Knowledge of federal and accreditation standards and regulations for the health insurance industry (URAC, NCQA, ACA, State Departments of Insurance and/or comparable regulatory bodies).

• PC skills and familiarity with various software packages including spreadsheets and presentations.

• Effective communication and written skills and ability to communicate and influence internal and external customers at all levels of the organization.

Preferred Job Qualifications:

• Experience with complex managed care concepts in a matrix management environment.

• Experience with project management involving multi-functional team members.

• Analytical skills including modeling.

• Experience in designing clinical programs.

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HCSC Employment Statement:

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.