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Company: Universal Health Services, Inc.
Location: Mcallen
Posted on: May 24, 2023

Job Description:


Job Summary: This position is responsible for the management of clinically complex Medicare Advantage members within the south Texas market. This includes individuals with significantly complex medical, behavioral health, substance abuse and/or social determinates of health needs. The goal of this role is to ensure these members are receiving appropriate and timely high-quality care to reduce unnecessary utilization. Will work closely with the Prominence Health Services team and a multidisciplinary care team to assist in developing an optimal plan of care using evidence-based practice standards of care. The Clinical Market Leader requires an advanced level of nursing knowledge and expertise to identify members within established utilization benchmarks and develop a detailed analysis and care plan to direct care coordination in both in-patient and out-patient settings. The development of the care plan should include in-person assessments and collaboration with the member and their care team to identify medical and social needs.

Qualifications & Requirements

  • Master's degree - Advanced Practice Register Nurse (APRN)
  • Active, unrestricted, current, and valid APRN license in the State of Texas.
  • Minimum Five (5) years of experience in a managed care environment focused on Utilization Management, Transitions of Care and/or Care Management. Equivalent combination of education and experience will be considered.
  • Minimum of five years (5) of clinical medical practice within a hospital or clinic setting.
  • Ability to effectively communicate in English and Spanish both verbally and in writing.
  • Strong analytical skills and ability to interpret data.
  • Strong problem-solving and critical thinking skills.
  • Experience executing strategies; organizing and prioritizing multiple projects and relationships with key stakeholders and program implementers.
  • Strong public speaking skills including large and small group presentations, group facilitation and training.
  • Superior interpersonal and oral/written communications skills
  • Ability to influence others and work collaboratively with key partners to achieve positive results.
  • Ability to present ideas and programs to key strategic alliances, professional volunteers, and funding partners.
  • Computer Skills: Smartsheet, SharePoint, Microsoft Office (Word, Excel, PowerPoint), and database software.
  • Empathetic, Caring, Compassionate Listener.
  • Able to work with a diverse multicultural and socioeconomic population.
  • Familiarity with health care delivery and/or health insurance programs.
  • Experience working with the Medicare and Medicaid population.
  • Knowledge of Medicare/ Medicaid processes and compliance standards
  • Ability to travel local and regional up to 50% of time. All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success. NoticeAt UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: or 1-800-852-3449.

Keywords: Universal Health Services, Inc., McAllen , CLINICAL MARKET LEADER, Healthcare , Mcallen, Texas

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