RN Supervisor of Case Management - Managed Care
*** This is a Full-Time, CONTRACT position expected to last 3 months or longer ***
Supervisor of Case Management Job Summary:
Supervisor of Case Management Background:
- Supervise the day-to-day activities of a unit of employees engaged in case management activities.
- 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.
- Provides oversight of staff duties as described in accordance with direction from department leadership.
- Current unrestricted state Registered Nurse (R.N.) license.
- Requires Bachelor of Science in Nursing (B.S.N.) or related field.
- Certification in Case Management, such as CCM is a plus.
- Around 2-3 years’ experience in direct clinical care in acute care provider environment.
- At least 2-3 years’ prior case management, care coordination, long term services and supports and/or discharge planning, MDS assessments, preferably for the elderly population.
- Around 1 year experience as a supervisor, or relevant experience leading and managing teams, including remote workforce.
- Experience with the Medicaid, Medicare, and / or senior population.
- Experience with ASAPs preferred.
- Knowledge of guidelines for Medicaid/Medicare and related state programs is required.
- Knowledge of health care delivery system, utilization review and case review procedures.
- Computer skills to include Microsoft Word, Excel and basic data entry.
- Strong oral and written communication skills; ability to interact within all levels of the organization and with external contacts.