RN 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 Manager of Case Management Job Summary:
RN Manager of Case Management Background
- Supervises clinical and support staff and acts as a medical resource to behavioral health clinical staff and managers to ensure practice standards that support care management are met
- Monitors staff productivity and balances staffing accordingly
- Ensures that the attribution of members into care management is based on clinical risk and acuity
- Assesses member acuity and monitors caseload assignment
- Oversees transition of care processes and ensures compliance with established practice guidelines
- Oversees the assessment of and care planning for members enrolled in a care management program
- Monitors care management practice through case reviews, chart audits and supervisory activities and identified opportunities for competency development
- Monitors staff compliance with webinars and training mandates and intervenes as needed
- Develops RN on call schedule and monitors any after- hours follow-up activity
- Identifies utilization risks and medical trend management opportunities
- Identifies members for rounds and leads the rounds process
- Actively engages in medical trend management opportunities
- Monitors compliance with clinical documentation
- Oversees adherence to Model of Care compliance, including audit readiness activities
- Ensures all care management policies and procedures are reviewed and recommends revisions
- Participates in quality improvement initiatives
- Follows up on member grievance and critical incident investigations
- Works with peers and the Senior Managers to monitor and analyze member attrition and improvement follow-up
- Valid, unrestricted state Registered Nurse (R.N.) license and BSN; Master's degree preferred.
- Roughly 3-4 years of acute care clinical nursing experience.
- Minimum of 3-5 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 5-7 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.