RN Supervisor of Case Management - Managed Care

Location: Salinas, CA
Date Posted: 06-29-2018
CareNational
RN Supervisor of Case Management - Managed Care
Salinas, CA
 
** Multiple Positions Open -  available in Merced, Salinas, or outside of Santa Cruz **  
 
Job Summary:
 
The primary responsibility of the Supervisor of Case Management is to monitor the assessment and development of nursing care plans, in collaboration with the admitting, attending, and consulting physician and other practitioners, while assisting the leadership with mentoring, training and oversight of the performance of assigned staff. The goal of the Supervisor is to ensure that nurse case managers effectively manage patients on an outpatient basis to assure the appropriate level-of-care is provided, to prevent inpatient re-admissions and ensure that the patients’ medical, environmental and psycho-social needs are met over the continuum of care. The position is responsible for auditing and providing oversight and training as identified for onsite and offsite offices to ensure compliance with Utilization Management policies and procedures and ensure compliance with all regulatory requirements. 
 
Position Description:
  • Supervise the day-to-day activities of a unit of employees engaged in case management activities. 
  • Identifies the need for and participates in the development and implementation of Care Management and Utilization Management policies and procedures and ensures compliance to promote cost-effectiveness and improved quality. 
  • Communicate effectively and functions as liaison between nurse and physician reviewers, medical directors, coordinators, PCP and specialist providers, regarding any UM or referral authorization issues, as well as care coordination issues.
  • Sets the example for the team by following through with requests, sharing of critical information, returning phone calls and getting back to individuals in a timely manner.
  • Works with the managers and directors to prepare the department for accreditation surveys using appropriate standards of performance.
  • Assist with the training of new requirements from state and federal regulations, health plan policy shifts, and corporate improvements
  • Assist with new referrals, chart auditing, and unique situations as necessary.
  • Communicates appropriately and clearly to management, co-workers, and physicians.
  • Interacts professionally with the patient, their family and their physicians and involves them in formation of the plan of care.
  • Documents patient assessment and reassessment, patient care plans, and other pertinent information completed in the patient’s medical record in accordance with nursing standards and policies.
  • Identifies community resources to address needs to cover through patient’s benefit plans.
  • Identifies non-compliant members eligible for health plan dis-enrollment.
  • Ensures that the nurse case managers demonstrate the ability to formulate an appropriate outpatient care plan, based on a telephonic assessment of patients’ needs and symptoms which addresses all key symptoms in order to effectively manage the patient on an outpatient basis.
  • Provide motivation and encouragement to subordinates, conduct performance evaluations and monthly reviews, identify and coordinate training needs, make determinations regarding disciplinary actions.
  • Provides oversight of staff duties as described in accordance with direction from department leadership.
 
Background Profile:
 
Valid and unrestricted state Registered Nurse (RN) license.
Certified Public Health Nurse (PHN) strongly preferred.
Requires Bachelor’s Degree in Nursing or related healthcare field.
Masters Degree and Case Management Certification (CCM) preferred.
At least 4-5 years’ experience in direct clinical care in acute care provider environment; Critical Care, ER, Telemetry, or Med/Surg inpatient experience is preferred.
1-2 years of recent Utilization or Case Management experience in a provider setting required.  Additional UM/CM experience in a managed care setting (HMO, IPA, Health Plan, or TPA) is a plus. 
2-3 years’ experience as a supervisor, or relevant experience leading and managing teams.
Computer literacy (MS Office) and strong typing skills are necessary.
Knowledge of utilization management, quality improvement, discharge planning, and cost management.
Possess planning, organizing, conflict resolution, negotiating and interpersonal skills.
Strong oral and written communication skills; ability to interact within all levels of the organization and with external contacts.
Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously.
Able and willing to occasionally travel in the area (10%-15%) - Company vehicle provided for travel!
 
The Reward:
  
EXCELLENT BENEFITS AND HIGHLY COMPETITIVE SALARY OFFERED!
Work with an exceptional organization focused exclusively on promoting the health care and quality of life for its members.  The forward-looking health plan has a demonstrated passion for finding innovative ways to enhance member’s ability to manage their own health. 
 
PRASHANT PATEL
STRATEGIC DIRECTOR
CareNational
prashant@carenational.com
480.646.3275 (CALL – TEXT – FAX)
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