Responsible for implementing and managing the case management/care coordination activities to control costs of high-risk, high-cost cases. Identifies cost-effective protocols for high-risk, high-cost diagnoses and develops cost-effective care plans. Develops guidelines for working with insurers, managed care organizations, patients, and families.
- Bachelor's degree required, Master's preferred, Case Management certification preferred.
- Demonstrated hands-on leadership and operational responsibility in a large/complex healthcare environment with 5-7 years' experience of successful management experience and in-depth understanding of managed care, experience in budgeting and strategic planning of goals and objectives, experience in statistical analysis and construction of reporting system.
- Expertise in financial analysis as well as clinical informatics
- Thorough knowledge of managed care utilization and quality management activities and requirements.
- Experience in healthcare compliance management
- Experience managing a variety of case management models using an interdisciplinary team approach.
- Understands financial impact of efficient resource management.
- Ability to hire, train and coach employees.
- Demonstrate understanding of competency-based criteria for case management.
- Ability to manage a complex, multiple hospital case management program
- Health System experience is preferred