Position Purpose: Perform duties to conduct and manage the day-to-day operations of the case management functions communicating with departmental and plan administrative staff to facilitate daily department functions.
· Oversee the workflow and day-to-day operations of the case management function
· Review analyzes of activities, costs, operations and forecast data to determine progress toward stated goals and statistical/financial purposes for case management
· Ensure compliance with federal and state regulations and contractual agreements
· Develop, implement and maintain compliance with policies and procedures regarding medical and social case management
· Develop, implement, and maintain case management programs to facilitate the use of appropriate medical and community resources and decrease health planfinancial exposure
· Ensure proper coordination and communication of medical service functions with other departmental functions at the business as assigned.
· Assist with provision of Medicare coverage and services
Education/Experience: Bachelor’s degree in Nursing, Social Work or equivalent experience. 3+ years of case management experience. Thorough knowledge of utilization management. Familiarity with Medicaid and Medicare managed care practices and policies, Children’s Health Insurance Program (CHIP), and State Children's Health Insurance Program (SCHIP). Supervisory or lead experiencepreferred.
License/Certification: Current state driver’s license and automobile insurance. Case Management Certification (CCM) preferred
Base Pay $80,000.00 - $95,000.00 /Year
Employment Type Full-Time
Job Type Health Care
Experience At least 3year(s)
Manages Others Yes
Industry Healthcare - Health Services
Required Travel Not Specified