Join a passionate team!
Position Purpose: Perform duties to conduct and manage the day to day operations of the case management functions communicating with departmental and plan administrative staff to facilitate daily department functions.
Review analyzes of activities, costs, operations and forecast data to determine progress toward stated goals and statistical/financial purposes.
Promote compliance with federal and state regulations and contractual agreements.
Develop, implement and maintain compliance with policies and procedures regarding medical case management.
Develop, implement, and maintain case management programs to facilitate the use of appropriate medical resources and decrease health plan financial exposure.
Facilitate on-going communication between case management staff, members, contracted providers, and subsidiaries.
Develop staff skills and competencies through training and experience.
Education/Experience: Bachelor’s degree in Nursing or equivalent experience. 3+ years case management experience and recent nursing experience in an acute care setting particularly in medical/surgical, pediatrics, or obstetrics and management experience. Thorough knowledge of case and/or utilization management and clinical nursing. Familiarity with Medicaid managed care practices and policies, CHIP, and SCHIP. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.
License/Certification: Unrestricted RN license in applicable state(s) and valid driver's license and automobile insurance. Case Management Certification (CCM) preferred.
This is an equal employment opportunities (EEO) to all employees and applicants without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status.
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REQ ID SCT