Case Management Manager

Milwaukee, WI

Post Date: 05/16/2017 Job ID: 21812 Category: Registered Nurse

Job Description:
  • 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.

Responsibilities:
  • 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.

Qualifications:
  • Must be an RN.
  • Must have 3-4 years of case management experience.
  • Previous experience as a lead in a functional area, managing cross functional teams on large scale projects.

A-Line Staffing Solutions

877-782-3334

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