RN Manager of Case Management

Location: Orange, CA
Date Posted: 08-31-2018
RN Manager of Case Management - Managed Care
Orange, CA
Manager of Case Management Job Summary:
  • Manager of Case Management provides clinical leadership for all Care Coordination programs by serving as an educator, role model, member advocate, and change agent to enhance member care and staff competency. 
  • Provides clinical guidance and supervision to all case management programs, based on accepted principles of nursing, social work, gerontology, geriatrics and case management practice.  
  • Develops, manages and participates in departmental projects, workflow processes, policies and procedures in collaboration with internal and external stakeholders. 
  • Ensures availability of specialized expertise to Medical Management programs by identifying case management needs and identifying and training subject matter experts.  
  • Uses a collaborative approach with the case management team in order to revise, develop, and implement cost savings methodologies and interventions. 
  • Facilitates communication with providers to ensure continuity of care and coordination between multiple specialists, providers, and vendors.   
  • The manager will ensure that policies and procedures are developed and enforced in alignment with the standards of patient care and regulatory bodies and that the core components of the case management process are followed.
Manager of Case Management Background:
  • Valid, unrestricted state Registered Nurse (R.N.) license and BSN; Master’s degree in healthcare related field preferred.
  • Roughly 3-5 years of recent acute care clinical nursing experience.
  • Minimum of 2-4 years’ Case Management experience; Certified Case Manager (CCM) preferred.
  • Around 5 years’ experience at a health plan or other managed care organization (HMO/TPA/IPA/etc).
  • Prefer 5 or more years of case management experience, ideally with a strong acute care CM background with more recent managed care CM experience.
  • Familiarity with Medicaid managed care practices and policies, CHIP, and SCHIP.
  • Experience in training / teaching staffs to meet operational requirements and goals.
  • Strong oral and written communication skills; ability to interact with all levels of internal and external contacts.
480.646.3275 (CALL – TEXT – FAX)
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