RN Senior Manager of Case Management – Health Plan
Boston, MA (west suburb, near Cambridge)
$$$ Generous Relocation Package available to attract top-talent from around the Nation! $$$
RN Senior Manager of Case Management Job Summary:
RN Senior Manager of Case Management Background
- The Senior Manager of Care Management ensures contract and regulatory compliance for the delivery of integrated care management, care coordination, and utilization management for the dual-eligible members under 65.
- Provides oversight for program management and ensures clinical integration across providers, Long Term Services and Supports (LTSS) and other community-based programs.
- Collaborates with the Product Team as needed and supports strategic planning initiatives based on ongoing product evaluation and feedback from EOHHS and CMS regulators.
- Responsible for the oversight of quality management and program evaluation activities, including contract requirements related to quality improvement projects, corrective action plans and critical incident follow-up.
- Supports performance management initiatives, including manages toward established targets based on key performance indicators (KPIs) and implements improvement strategies as needed.
- Drives program performance through ongoing oversight of care management practice and as informed by analysis of key performance indicators
- Valid, unrestricted state Registered Nurse (R.N.) license and BSN; Master's degree preferred.
- Roughly 10 years of acute care clinical nursing experience.
- Minimum of 5 year’s Case Management experience; Certified Case Manager, (CCM) preferred.
- Around 5 year’s managerial experience and, preferably including leadership of Case Management staff within a managed care or hospital environment.
- At least 3-5 years of experience at Managed Care Organizations (MCOs), such as Health Plans, HMOs, IPAs, TPAs, tec
- Ability to analyze and integrate information and make sound decisions based upon established guidelines.
- Resourcefulness as demonstrated by the effective application of professional knowledge to new situations. Possess planning, organizing, conflict resolution, negotiating and interpersonal skills.
- 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.
- Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously.