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Title Manager Case Management
Role Case Management
Category Healthcare Services - Nursing
Location USA - Ohio - Canton
Company FPSJobsIndiana.com ,  Vacancies [ 1 ]
Experience 2 to 5 Years
Educational Qualification Bachelors: BA, BSEE, BSME, BS Nursing, CPA
Skills Nurse
Salary Minimum - 67,000.00, Maximum - 80,000.00 USD Per Year
Career Level Management (Manager/Director of Staff /Physician-MD Pharmacist)
Job Type Permanent
Job Status Full Time
Canton , OH , United States

Direct and coordinate activities related to the case management function to further attainment of goals and objectives of the department, health plan and Company. Assign work through matrix structures as necessary.

Manage the day-to-day operations of the case management and utilization management functions communicating with departmental 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 objectives. Assure compliance with established on site and concurrent review, case management, referral, pre-certification and authorization policies, procedures and processes.

Assure compliance with plans emergency management policies, procedures and processes. Promote compliance with federal and state regulations and contractual agreements. Perform case management, disease management and on-site concurrent review functions as necessary.

Assist staff with the resolution of computer systems issues related to the utilization and case management functions. Develop, implement and maintain policies and procedures regarding medical case management and utilization management functions.

Develop, implement, and maintain case management programs to facilitate the use of appropriate medical resources, decrease health plan financial exposure, and create performance standards.

Compile and review multiple reports on work function activities for statistical and financial tracking purposes to identify utilization trends, assist in financial forecasting, and make recommendations to management. Monitor and report on achievement of committed action plans to appropriate health plan and corporate management.

Must be an RN, Bachelors degree in nursing or equivalent, advanced degree a plus, and 3 5 years case management, utilization management and recent nursing experience in an acute care setting particularly in medical/surgical, pediatrics, or obstetrics and management experience. Thorough knowledge of case and/or utilization management and clinical nursing.
Familiarity with Medicaid managed care practices and policies. Case Management Certification (CCM) preferred. RN required.

EDUCATION: Must be an RN, Bachelors degree in nursing or equivalent, advanced degree a plus


KEYWORDS: Health Care , medical/surgical, pediatrics, or obstetrics (general)

COMPENSATION RANGE: 67000 to 80000 / yr
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