RN Case Management Supervisor

Location: This position is full-time (40 hours/week) Monday–Friday from 8:00 am–4:30 pm and will be fully remote. The candidate may be asked to come on-site for training, meetings, or other business needs.

Responsibilities

• Supervises day-to-day activities for assigned staff.
• Identifies training needs of staff.
• Verifies accuracy, efficiency, and effectiveness of workflow functions.
• Develops and oversees the implementation and administration of specialty programs (wellness, preventive, and/or employer work site programs).
• Supervises staff to include approval of time, leave, performance reviews, etc.
• Selects, trains, and motivates staff in providing excellent customer service with customers, marketing, management, and others.
• Develops, maintains, and updates procedures/documentation for conducting audits.
• Develops and communicates department standards and expectations of staff.
• Performs quality control functions for work performed.
• Develops work plans to improve quality performance.
• Conducts analysis of program components.
• Collects data for outcomes reporting.
• Prepares, reviews, and maintains weekly/monthly reports for management.
• Oversees all data collection and URAC/NCQA compliance activities for related programs.
• Coordinates with other corporate departments to ensure effective communication.

Requirements

• Associate's degree in a job-related field or graduate of an accredited school of nursing.
• 5 years of combined experience in health promotion, health education, health insurance, clinical, medical, pharmacy, or other healthcare experience. If Master’s degree, required experience is three years.
• One year of experience in a team lead/leadership role or equivalent military experience in grade E4 or above (may be concurrent).
• Active, unrestricted RN licensure from the United States and in the state of hire, OR active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), OR active, unrestricted professional healthcare licensure and/or certification from the United States and in the state of hire in area of specialty, OR active, unrestricted licensure as Licensed Master Social Worker, Licensed Independent Social Worker, or Licensed Professional Counselor from the United States and in the state of hire, OR if Master's in Public Health or Healthcare Administration, three years of additional experience in a health-related field.
• Must be certified in Case Management by a URAC accrediting body within 3 years of hire into the position (for non-Medicaid only).
• Proficiency in Microsoft Office.

Skills

• Understanding of insurance and benefit programs as they relate to health management coverage.
• Working knowledge of managed care and/or various forms of healthcare delivery systems.
• Knowledge of specific criteria/protocol sets and their use.
• Knowledge and understanding of the quality improvement process.
• Ability to work independently, prioritize effectively, and make sound decisions.
• Excellent communication skills.
• Ability to work with a wide variety of internal and external customers.
• Strong judgment skills.
• Demonstrated customer service, organizational, and presentation skills.
• Strong verbal and written communication skills.
• Analytical, critical thinking, and math skills necessary to collect, analyze, and report data.
• Ability to persuade, negotiate, or influence others.
• Ability to handle confidential or sensitive information with discretion.
• Ability to direct, motivate, and assess performance of others.

Qualifications

At least 3 years of leadership experience (supervisor and above) in a Care Management role is preferred.

Benefits

• Subsidized health plans, dental, and vision coverage.
• 401k retirement savings plan with company match.
• Life insurance.
• Paid Time Off (PTO).
• On-site cafeterias and fitness centers in major locations.
• Education assistance.
• Service recognition.
• National discounts to movies, theaters, zoos, theme parks, and more.