Supervisor, Case Management
- 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.
- 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.
- Valid driver' s license.
- Current state' s RN license.