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RN Manager of Case Management

Boston, MA · Healthcare
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:

  • 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 
RN Manager of Case Management Background

  • 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.


480.646.3275 (CALL – TEXT – FAX)
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