Manager, Medical Case Management

About the role

The Manager, RN Branch Manager of Telephonic Case Management for Workers Compensation oversees operations and a team of nurse case managers. Key responsibilities include managing caseloads, ensuring compliance with regulations, and leading performance improvement initiatives.

Responsibilities

• Manage, develop, and direct staff to deliver high-quality managed care services involving medical and disability case management.
• Oversee operational and administrative activities, ensuring adherence to established standards and protocols.
• Evaluate and assess injured worker outcomes, identify continuous improvement opportunities, and ensure key performance metrics are met.
• Recruit, coach, and develop staff to enhance their skills and promote talent within the organization.
• Manage performance management programs, including communication of objectives, ongoing coaching, and performance reviews.
• Make recommendations to Zonal Directors regarding promotions, terminations, and staffing authorizations.
• Maintain technical expertise and serve as a resource for staff, referring issues outside of authority to higher management.
• Achieve compliance with all relevant legislation, corporate policies, and programs.
• Support new business and renewal presentations, claims service reviews, and policy implementation.

Qualifications

• Advanced knowledge of principles and methods pertaining to the specific department and company operations.
• Active unrestricted RN license in the U.S., with eligibility to get and/or renew a multistate license.
• Bachelor's degree in nursing (BSN) or equivalent work experience preferred.
• National Certification in case management or the ability to obtain certification within 24 months of employment.
• Experience in workers' compensation laws and regulations, case management practice, and URAC standards.
• Excellent communication, leadership, and interpersonal skills.
• Knowledge of pharmaceuticals, pain management, and behavioral health.