Supervisor, Case Management

Philadelphia, PA

Posted: 02/25/2019 Category: Registered Nurse Job Number: 25361
Position Purpose:
  • Supervise the day to day operations of the case management function.
  • Communicate with departmental and plan administrative staff to facilitate daily department functions.
  • Assure compliance with established referral, pre-certification and authorization policies, procedures and processes by related Medical Services staff.
  • Assure compliance with established onsite and concurrent review, case management, referral, pre-certification and authorization policies, procedures and processes.
  • Assure compliance with emergency management policies, procedures and processes.
  • Facilitate on-going communication between case management staff, utilization management staff and contracted providers.
  • Assist with the implementation of policies and procedures regarding medical case management.
  • Maintain compliance with federal and state regulations and contractual agreements.
  • Coordinate and communicate medical service functions with other departmental functions.
  • Act as medical resource for appeals function.
  • Assist Medical Services staff with computer systems issues related to case management.
  • Conduct telephonic review of cases with doctors, hospitals, and other providers.
  • Compile and review multiple reports for statistical and financial tracking purposes to identify case management trends and assist in financial forecasting.

Education/Experience:
  • 3+ years of nursing experience in an acute care setting particularly in a medical/surgical, pediatrics, or obstetrics environment.
  • 1+ year of case and/or utilization management experience.
  • Working knowledge of a specialized or technical field such as clinical nursing, case and/or utilization management.
  • Previous experience as a lead in a functional area or managing cross functional teams on large scale projects.
  • Data management experience preferred.

License/Certification:
  • Valid driver' s license.
  • Current state' s RN license. 
For more information on this position, please contact our office at 877-782-3334.
 

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