Express Scripts Director, Field Nurse Program Operation in St. Louis, Missouri

POSITION SUMMARY

The Director - RN Clinical is responsible for the day to day medical management operations, inclusive, but not limited to maintaining production metrics, delivering on current service level agreements, fulfilling contractual requirements and supporting future state initiatives while meeting strategic, operational and budgetary targets. Additionally, the continued development of solid clinical quality programs and robust clinical training are requirements, as well as the execution of appropriate utilization management policies and procedures. In collaboration with key business partners, the Director - RN Clinical shall identify operational opportunities and areas for process development, improvement and administration applicable to clinical product offerings.

ESSENTIAL FUNCTIONS

  • Oversee operational performance relating to Operational metrics, Quality measures, Contractual requirements, Execution of MBM policies and procedures and Clinical appropriateness.
  • Oversee the administration of clinical programs, including application of medical policy, utilization management processes and practices while remaining compliant with contractual and regulatory requirements.
  • Development and implement solid clinical quality programs that support current state needs and future product services.
  • Align with key business partners to support the ongoing development of future MBM product offerings.
  • Accountable for the design and execution of the UM work plan and associated tasks.
  • Continual identification of operational opportunities to gain efficiencies, improve processes and workflow and develop best practices.
  • Oversee clinical training to maintain highly effective clinical programs, support contractual obligations and meet regulatory standards.
  • All other duties as assigned.

QUALIFICATIONS

  • Bachelor’s degree in relevant discipline.
  • 10-15 years relevant experience or Master’s degree with 8-12 years relevant experience.
  • Registered Nurse.
  • Solid PC navigation skill set.
  • Working knowledge of Microsoft Office.
  • Excellent verbal, written communication and presentation skills.
  • Solid understanding of the health insurance industry.
  • Ability to navigate and support both public and private insurance/plan requirements.
  • Managed care exposure.
  • Understanding or ability to implement utilization management principles.
  • Proven leader in a clinical ops environment.

ABOUT THE DEPARTMENT

The Pharmacy Operations Group is crucial to achieving our mission of practicing pharmacy smarter and putting medicine within reach. Members of this team are at the front line every day interacting with patients, strategizing on improvements and efficiencies, and processing the more than one million prescriptions that come through our work-class pharmacies and distribution facilities across the country.

ABOUT EXPRESS SCRIPTS

Advance your career with the company that makes it easier for people to choose better health.

Express Scripts is a leading healthcare company serving tens of millions of consumers. We are looking for individuals who are passionate, creative and committed to creating systems and service solutions that promote better health outcomes. Join the company that Fortune magazine ranked as one of the "Most Admired Companies" in the pharmacy category. Then, use your intelligence, creativity, integrity and hard work to help us enhance our products and services. We offer a highly competitive base salary and a comprehensive benefits program, including medical, prescription drug, dental, vision, 401(k) with company match, life insurance, paid time off, tuition assistance and an employee stock purchase plan.

Express Scripts is committed to hiring and retaining a diverse workforce. We are an Equal Opportunity Employer, making decisions without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other protected class. Applicants must be able to pass a drug test and background investigation. Express Scripts is a VEVRAA Federal Contractor.

*LI-CE1