Manager of Case Management (RN)

Diamond Bar, CA 91765

Posted: 07/31/2018 Profession: RN Management Job Number: 43345

Our client, an established and growing Health Plan, is in need of a Registered Nurse Manager of Case Management to add to the team. Ideal candidate has 2-3 years of Case Management experience in a Health Plan setting with some experience leading, supervising, or managing a team. This is a direct-hire, full-time, salaried position with excellent compensation and benefits package.

Overview:

  • The Registered Nurse Manager of Case Management is responsible for oversight of 10 Direct Reports in the Case Management department.
  • The Manager of Case Management/Utilization Management department works under the general direction of the Director of Case Management providing shared responsibility for the daily operations, activities and projects for the Case Management Department.
  • Provides oversight for Inpatient and Outpatient Case Management staff, including assistance in Concurrent Review and Utilization Review and Appeals and Grievances.
  • Participates in hiring, training, orienting staff. Provides performance reviews and ongoing management and development of staff.
  • Provides consultation to case managers, coordinators and UR lead/supervisor on difficult cases and provide a second opinion, expertise and problem solving assistance.
  • Works with the Director of Case Management in the development, implementation and evaluation of the department s case management policies and procedures.
  • Involved in Quality Assurance and Compliance; ensures programs, policies and procedures in alignment with CMS, DHCS and NCQA standards.
  • Collects, analyzes and responds to data regarding overall and individual case management effectiveness.
  • Develops and implements complex project plans which will improve efficiencies, outcomes and satisfaction and which may be directed by federal and/or state regulations.

Qualifications:

  • Active California Registered Nurse License
  • 1-2 years Supervisor Experience in a Managed Care setting, preferably in Case Management or Utilization Management.
  • 2-3 years clinical experience in geriatrics, managed care, or acute care
  • Excellent communication skills
  • Familiarity with Microsoft Office Suite, as well as clinical guidelines such as Interqual, Milliman, etc.

Benefits:

  • Direct-hire, full-time, salaried position with large nation-wide organization
  • Medical, dental, vision, life insurance, 401K, vacation and PTO
  • Opportunities for growth
  • Inviting company culture with strong value on delivery of quality care

This is a direct-hire, permanent, full time salaried opportunity with excellent benefits and compensation package. Please submit your resume to Kasey at kklumpp@medicalprofessionals.com to learn more about our client! No resume? Call/Text Kasey @858.609.0858 to learn more!

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