PRIMARY PURPOSE: To ensure efficient, cost effective and high quality delivery of case management services to clients for a single business line by supervising and training a staff of centralized case management specialists and overseeing the management of cases worked by field specialists; and to ensure customer satisfaction through the provision of these services and through dealing directly with workers' compensation department managers, supervisors, nurse case managers and examiners utilizing the account management process and/or system applications.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
- Manages, coordinates and reviews the work of assigned staff for a single business line.
- Acts as liaison between telephonic and onsite case management.
- Participates in account support and management.
- Ensures achievement of unit financial goals and customer service/satisfaction goals.
- Provides expert medical and product support to staff.
- Audits case management staff routinely to ensure compliance with regulatory requirements and URAC standards.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
- Performs other duties as assigned.
- Supports the organization's quality program(s).
- Travels as required.
- Administers company personnel policies in all areas and follows company staffing standards and training recommendations.
- Interviews, hires and establishes colleague performance development plans; conducts colleague performance discussions.
- Provides support, guidance, leadership and motivation to promote maximum performance.
Education & Licensing
One of the following required:
- BS/BA degree or higher in a health-related field AND licensure as a health professional OR
- Certification as a case manager OR
- Professional certification in a clinical specialty AND three (3) years experience as a case manager
NOTE: Certification as a case manager is required if directly supervising the case management process for three (3) or more years.
Eight (8) years of related experience or equivalent combination of education and experience required to include two (2) years of clinical experience and two (2) years of workers' compensation experience. Supervisory experience preferred.
Skills & Knowledge
- Solid knowledge of medical case management
- Knowledge of resources available regarding the regulations and parameters of third party reimbursement
- Knowledge of statutory requirements of state's jurisdiction
- Excellent oral and written communication skills
- PC literate, including Microsoft Office products
- Leadership/management/motivational skills
- Analytical and interpretive skills
- Strong organizational skills
- Excellent interpersonal skills
- Excellent negotiation skills
- Ability to work in a team environment
- Ability to meet or exceed Performance Competencies.