Senior Director, Case Management
- Oversee case management operations for the health plan.
- Define and direct the case management program for the plan in conjunction with corporate goals and objectives.
- Lead and direct the overall operation of the case management function to ensure consistency of policies, procedures and work flows.
- Ensure member and provider satisfaction with case management program.
- Evaluate case management program effectiveness and recommend improvements.
- Ensure case management targets for all products are met for the annual operating plan, state requirements and financial management
- Ensure that utilization management process is integrated with case management program.
- Maintain compliance with National Committee for Quality Assurance (NCQA) standards for case management function.
- Identify quality and risk management issues and facilitate the collection of information for quality improvement and reporting.
- Review various reports and identify trends to assist in financial forecasting.
- Education/Experience: Bachelor' s degree in Nursing, related field, or equivalent experience.
- 7+ years of nursing experience in an acute care setting or complex case management experience.
- Experience in managed care environment.
- License/Certification: RN license.