Case/Care Management Manager
Rancho Cordova, CA
Manager, Care Management (RN) -Rancho Cordova, CA
Looking for a Registered Nurse with Management and Care Management experience to lead a team of Case Managers for a large health plan.
What is exciting about this opportunity?
- Excellent starting salary +bonus!
- 401k with matching 50% up to 6%
- 11 paid holidays +18 PTO +4 Sick days
- Tuition reimbursement
- Medical / Dental / Vision / Life / STD & LTD
RN Manager Care Management Job Duties:
- Effectively manages a case management team and provides leadership and management of the services and activities of the regional case management function.
- Actively promotes an organizational culture committed to high quality customer service to clients and their families, physicians and other members of the health care delivery system. Works collaboratively with contracting department, provider relations and administrators for the development and maintenance of clinically appropriate, cost effective case management processes.
- Develops policies and procedures to improve efficiency and ensure a focus on outcomes.
Leadership- Effectively manages the activities of the Case Management Team, providing leadership and guidance:
- Interviews, recommends for hire and evaluates staff, counsels and confronts unsatisfactory performance promptly and fairly and administers corrective action.
- Identifies department goals and objectives, develops and communicates action plans through regular staff meetings and other communications, uses team approach to problem solving and sets clear expectations.
- Identifies training needs and develops and participates in staff training.
- Provides a challenging and supportive environment and delegates appropriately. Seeks additional Training opportunities through outside sources.
- Develops monitoring systems and measurements and exhibits a customer service philosophy.
- Establishes monitoring linkages between Transitional Care and other internal entities and departments when necessary.
- Coordination of health care services- Directs the effective coordination of health care services to achieve program goals and objectives:
- Ensures that case management services comply with URAC and ISO standards by implementing applicable policies and procedures.
- Communicates Health Net Federal Services Goals and Objectives to the case management team and plans activities and strategy.
- Works closely with the provider relations department to identify contractual needs in specific areas.
- Researches and identifies appropriate equipment that will meet the beneficiary’ s needs in specific areas.
- Operation Management- Manages the operations of the case management team to ensure best value health care services are delivered in a manner that satisfies beneficiaries:
- Facilitates complex clinical and financial decision making by presenting thoroughly analyzed cases requiring higher administrative approval or intervention.
- Works with staff in claims and billing departments to resolve complex claims and follows to resolution.
- Negotiates with providers in securing coverage for services medically necessary and financially sound.
- Collaboration- Establishes integrated continuous quality improvement process to assure high quality care, customer satisfaction and contribution to financial performance:
- Incorporates new work processes and approaches to improve efficiency and quality services.
- Provides guidance to case management in resolving problematic situations with beneficiaries and families, physicians and external entities. Investigates and responds to client and provider complaints regarding quality of care.
- Meets and collaborates with the MTF liaison regarding specific cases and troubleshoots high profile cases.
- Training- Participates as a hands-on team member training when appropriate and keeps team professionally current:
- Assists staff as needed on difficult cases provides educational opportunities with new and difficult cases.
- Keeps current on industry trends and new development.
- Participates in and seeks educational forums for self and staff.
- Participates in and involves staff in professional organizations
- Education/Experience: Graduate of a Nursing program, BSN preferred or an LCSW.
- Minimum of 5 years clinical experience
- 3 years supervisory/management experience in a health care environment
- Previous supervisory/management experience in Care Coordination, Nurse Advice/Triage, Case or Disease Management operations. Experience planning, leading and organizing the resources of a team preferred
- Leadership experience in a managed health care setting preferred
- Experience with clinical assessment for clients with complex medical emotional and social needs. Ability to understand and apply contractual guidelines. Experience coaching, counseling and administering corrective action
Managed Care, Medicare, Medicaid, case manager, care manager, utilization review, care coordination, disease management, Nurse, Registered Nurse, Transitional Care