Manager, Case Management

Role Overview

• Participate in development of Clinical Programs’ strategy and planning in accordance with company's mission and strategic goals, federal and state law and regulations, and accreditation standards.
• Assist in the selection, training, evaluation, and development of professional paraprofessional, and administrative team members.
• Lead Care Management teams in effective performance of job functions, which may include preauthorization, outpatient and inpatient management, case management, retrospective claim review, and delegated management oversight.
• Participate in the development and monitoring of budgets in accordance with department and organizational objectives.
• Assist with the adjustment and direction of work processes to support cost and utilization variations.
• Participate in the development, implementation, and monitoring of the department's performance standards, utilizing quality improvement methodologies to refine procedures.
• Participate in the establishment and implementation of Care Management policies as required.
• Foster collaborative work environment that encourages team building, facilitates cohesive synergetic performance of Care Management functions, while valuing the individual diversity and uniqueness of all employees.
• Build and maintain cooperative business relationships.
• Participate in Total Quality Management activities and processes to assure operational compliance with regulatory requirements, including NCQA, NEMIS, HCFA, and OIC.
• Ensure team members that can articulate the expectations of performances are invested in productivity and customer service, and can describe a positive feeling about the work environment.
• Effectively manages deficits with improvement plans and consistent follow-up.

Requirements

• Candidates with a RN License are highly preferred.
• Current state credential (e.g. licensure) that allows the professional to conduct an assessment independently as permitted within the discipline's scope of practice (Required) :
• For nurses, required registration (e.g. RN, ARNP).
• For behavioral health, required licensure (e.g. LMFT, LICSW, LPC, LMHC)
• For psychologist, required board certification
• For dietitians, required certification as a nutritionist or dietician
• Or licensure in related healthcare discipline
• Certified in CCM (Certified Case Management) or obtain certification within 24 months of date of hire. (Required)
• Five (5) years case management or health care experience. (Required)
• Three (3) years management experience. (Required)
• Advanced degree such as Master's Degree in a Health-Related field preferred.
• Experience with NCQA, URAC, or accreditation review processes
• Experience in continuous process improvement and creative problem solving (e.g. LEAN, Synectic)
• Advanced training in Motivational Interviewing
• Experience training clinical and non-clinical staff
• Experience managing case management teams and integrated case management model

Benefits

• Medical, vision, and dental coverage with low employee premiums.
• Voluntary benefit offerings, including pet insurance for paw parents.
• Life and disability insurance.
• Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service.
• Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few.
• Generous paid time off to reenergize.
• Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees.
• Employee recognition program to celebrate anniversaries, team accomplishments, and more.
• For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.
• Commuter perks make your trip to work less impactful on the environment and your wallet.
• Free convenient on-site parking.
• Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.
• Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.
• Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.
• Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus.