Case Management Program Manager

Role Overview

• Manage the TOP Case Management Program to identify and support the management of healthcare for individuals with high-cost conditions.
• Collaborate with superiors, peers, and subcontractors.
• Ensure professionalism when dealing with beneficiaries and colleagues.
• Apply medical knowledge to complex requests for medical care.
• Maintain an overview of challenging or complaint cases and provide direction as needed.
• Monitor the case managers’ workload and case assignment.
• Review and document case/cost savings due to the TOP CMP.

Requirements

• 3+ years clinical experience required.
• US RN licensure required.
• Nursing education qualification with maintained governance appropriate to country / body of qualification.
• Case Management certification by recognised US body.
• Managed care experience preferred.
• TRICARE experience preferred.
• Attention to detail.
• Broad Medical Knowledge.
• Effective communication skills.
• Converses fluently in English.
• Ability to provide clear and concise written updates in English.
• Knowledge or familiarity with the TRICARE Overseas Program (preferred).

Benefits

• Provide TOP CMP induction and ongoing role specific education, support, coaching and direction to the CMNs.
• Provide TOP CMP education to other key stakeholders on an ad hoc / as required basis, i.e., Operations, TPSS etc.
• Maintain a high level of client and procedural knowledge and ability to engage and interface with the client where appropriate.
• Participate in monthly TOP CMP case presentations to the TRICARE Area Office Medical Director/s and Nurses.
• Support the completion and review of the annual CDRL – P050 Case Management Program Plan.
• Attend supervision, training, and departmental meetings as and when required.
• Flexible hours as appropriate to the needs of the post.