Manager, Medical Case Management

Responsibilities

• Manage, develop and direct staff to ensure the delivery of high-quality managed care services involving medical and disability case management achieving best in class outcomes for our customers and their injured workers.
• Responsible for all oversight of operational and administrative activities within the department/unit.
• Ensure staff adheres to established standards and protocols to effectively manage assigned caseload of medical and disability cases to evaluate and assess for optimal injured worker outcomes, continuous improvement opportunities, assure key performance metrics are met and/or exceeded.
• Recruits, coaches, develops staff to broaden and strengthen the skill sets to further promote talent within the organization both laterally and management opportunities, creating a high performing results-oriented staff.
• Manages salary (and no-salary) budgets, makes recommendations to Zonal Director and leadership concerning promotions, terminations, and staffing authorizations.
• Manages performance management programs including communication of objectives, providing on-going coaching and conducting performance reviews, and as applicable initiate progressive disciplinary actions.
• Acts as a technical expert and resource for staff which includes maintaining the highest level of authority within the department/unit specific office. Technical expertise and resource knowledge for all levels of care coordination from low to high severity or complex cases. Appropriately refers issues/concerns outside of authority level to Zonal Management level.
• Ensures appropriate compliance with all legislation, corporate policies, and programs.
• Affords assistance to Zonal Management and other departments with new business and/or renewal presentations and periodic claims service reviews.
• Implements new and revised policies and procedures.
• Performs additional duties and/or is assigned special projects as requested.

Qualifications

• Advanced knowledge of principles and methods pertaining to the specific department, knowledge of department management practices, company operations (i.e. other staff and line departments), and policies.
• Active unrestricted RN license in a state or territory of the United States with eligibility to get and/or renew a multistate license is required.
• Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work experience preferred.
• National Certification in case management OR the ability to obtain certification within 24 months of employment is required.
• Written and verbal fluency in Spanish and English preferred.
• Overall five (5) years of related case management experience or equivalent combination of education and case management experience required to include three (3) years of management or leadership role experience in case management.
• Preferred previous clinical experience orthopedic, emergency room, critical care, home care or rehab experience.