Health Operations Clinical Liaison
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POST DATE 9/13/2016
END DATE 11/14/2016
Horizon Blue Cross Blue Shield of New Jersey
JOB DESCRIPTIONJob Summary:
This position is accountable for the activities of project planning, development and implementation, and the establishment of policies and procedures pertaining to Health Services. Also provides research and support to the Chief Medical Officer on a variety of issues.
* Develop project initiatives and strategies to include goals, objectives and timelines.
* Establishes project management methodology and practices consistent with Divisional objectives.
* Monitors the performance of goals and reports progress to management.
* Acts as a liaison for internal and external areas.
* Responsible for strategic planning of systemic enhancements to improve the quality and efficiency of project initiatives.
* Participates on divisional Workshops to ensure efficient processes to meet project objectives.
* Performs special projects and duties as assigned.
* Assists Director with key departmental initiatives, projects and activities.
* Attends meetings with the Director or acts as a representative at meetings with decision making ability.
* Acts as clinical SME with analytics to assist in preparation of required ongoing reporting.
* Ensures that all information necessary for decision making is coordinated and any necessary documentation is prepared.
* Provides external clinical representation to Physicians and other health care professionals to promote Divisional clinical improvement activities.
* Attends staff meetings and is responsible for following-up on meeting outcomes.
* Requires knowledge of project management methodology.
* Requires knowledge of healthcare management.
* Requires working knowledge of PC and application software.
* Requires knowledge of medical management platform and analytics.
* Requires clinical knowledge of NCQA, HCAPPA, Fed Regs, DOL, CMS, DOBI and mandates.
Skills and Abilities:
* Requires the ability to apply project management methodologies and practices across multiple projects.
* Requires comprehensive leadership and decision making ability.
* Requires excellent analytical and problem solving skills.
* Requires excellent verbal and written communications skills.
* Require excellent presentation skills.
* Requires clinical knowledge of common medical conditions pertinent to population we serve.
* Requires a Bachelors Degree in Nursing, Insurance, Health Management or related field.
* Prefer a Masters degree in Healthcare Management.
* Requires five years professional business experience working in a clinical environment.
* Prefer five (5) years managed care experience.
Additional licensing, certifications, registrations:
* Preferred unrestricted Registered Nurse, Pharmacist or Licensed Clinician.
Travel % (If Applicable):
* As needed
Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law.
--Horizon NJ Health