Health Care

applicant

Be a part of growing and developing the medical management team!! Reporting to the VP of Medical Management, experienced case manager will  monitor and evaluate the Utilization and Case Management program and is responsible for training and supervising Case Management staff. She/he is responsible for managing the day-to-day operations of the case management and utilization management functions and plan administrative staff to facilitate daily department functions.Review analysis of activities, costs, operations and forecast data to determine progress toward stated goals and statistical/financial purposes.        Promote compliance with federal and state regulations and contractual agreements.  Develop, implement and maintain compliance with policies and procedures regarding medical case management.Develop, implement, and maintain case management programs to facilitate the use of appropriate medical resources and decrease health plan financial exposure.Facilitate on-going communication between case management staff, members, contracted providers, and subsidiaries.  Develop staff skills and competencies through training and experience.  Knowledge/Experience:   Registered nurse with Bachelor’s degree in nursing or equivalent.  2-4 years supervisory experience, preferably in a managed care environment. 3 " 5 years hands on case management and utilization management experience. Familiarity with Medicaid managed care practices and NCQA standards is highly desirable.  Recent nursing experience in an acute or home care setting. Managed care experience is preferred. Licenses/Certifications:  Current registered nurse in applicable state(s) and state driver’s license and automobile insurance. Case Management Certification is a PLUS - not required.OUR FIRM:Health Career Professionals, LLC is a health care staffing and recruiting firm who provides professional services to health care workers and companies.  Our clients are national and regional health care plans who seek the services of clinical and operational professionals in contract, interim, and permanent positions.By applying to this position you are agreeing to receive additional information from our firm and our periodic email newsletter about new opportunities and career information.  Your personal information is NEVER released to any third parties.