Case Management Manager
- 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.
- 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.
- Unrestricted RN license in applicable state(s) and valid driver's license and automobile insurance.
- Case Management Certification (CCM) preferred.
- 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