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RN-Health Management Supervisor-Managed Care

RN-Health Management Supervisor-Managed Care

Job Description



This represents a working supervisor position and includes Utilization, Case Management and Disease Management functions. The supervisor coordinates resources and creates flexible, cost effective care options for “at risk" members to facilitate quality, individualized pursuit of health.  The Health Management Supervisor is also responsible for supervising designated employees in the Health Management Department and works cooperatively with all members of the health care team to maximize outcomes and decrease utilization.  

RESPONSIBILITIES:

             Nurse care manager responsibilities

  • Develop and maintain collaborative and proactive relationships with members and Provider partners, to maximize member health care outcomes.
  • Evaluate the appropriateness, necessity, and quality of health care provided to members.  Compliance with regulatory time restrictions.   Utilization programs include: pre-authorization for services and concurrent hospital stay reviews / planning.  
  • Care-coordination activities ensuring appropriate linkages between members, providers, community-based healthcare services and state and local agencies. 
  • Case Management for members identified as having catastrophic, chronic or special healthcare needs.   This includes but is not limited to:
  1. Assessing and monitoring the individual's clinical treatment plan to achieve best outcome, and most cost effective use of health care services.
  2. Assessing for gaps in care, including medical, dental, mental health, and substance use domains.




Job Requirements

  • BSN in Nursing with advanced study in case management and/or psychology/social work; 
  • Certified Case Management Certification
  • Experience working in a health plan setting;
  • Knowledge of Interqual utilization criteria;
  • Experience using QNXT
  • Experience in managing patients and/or programs with Behavioral Health/Chemical Dependency

 

EDUCATION AND EXPERIENCE:

  • Associates or bachelor’s degree in nursing
  • Three to five years supervisory experience and/or experience in case management/utilization management in addition to degree.
  • Washington State RN or LPN license, without restriction

Abe Ghebrehiwet

Senior Account Executive

Nurse Resolutions

888.411.2228. X 204 Toll Free

407.982.7508. Fax          

www.NurseResolutions.com

[Click Here to Email Your Resumé]


Job Snapshot

Employment Type Full-Time
Job Type Nurse, Health Care, Insurance
Education Not Specified
Experience Not Specified
Manages Others Not Specified
Industry Insurance, Healthcare - Health Services, Managed Care
Required Travel Not Specified
Job ID 1583
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RN-Health Management Supervisor-Managed Care


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