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RN - Supervisor of Case Management - Managed Care

RN - Supervisor of Case Management - Managed Care

Job Description

Job Summary
Responsible for  overseeing the Integrated Case Management staff focused on assisting Healthcare members with their health care needs to achieve optimal clinical, financial and quality of life outcomes.  Monitors information daily as appropriate including member metrics and staff productivity. Evaluates the services provided and outcomes achieved by the team and recommends enhancements and/or improvements for programs and staff development to ensure consistent cost effectiveness and compliance with all state and federal regulations and guidelines in day-to-day activities.
Essential Functions
• Oversees, coordinates and monitors all Case Management team clinical and non clinical team activities to facilitate integrated proactive utilization management.
• Functions as hands-on supervisor for daily integrated Case Management activities including Long Term Care and Behavioral Health.
• Manages and evaluates team members in the performance of various case management activities.
• Performs and promotes interdepartmental integration and collaboration to enhance the continuity of care for Molina members.
• Works with the Manager of HCS to ensure adequate staffing and service levels, and maintains customer satisfaction by implementing and monitoring staff productivity and performance indicators.
• Maintains effective team member relations.
• Conducts regular staff meetings.
• Assists with selection, orientation and mentoring of new team members.
• Conducts performance evaluations in a timely manner.
• Provides coaching, counseling and employee development and meets individually with staff at least monthly.
• Recognizes exceptional employee performance.
• Completes quality audit reviews for all Case Management staff.
• Assists team members in improving skills, creativity and problem solving.
• Collaborates with and keeps the Manager of Healthcare Services appraised of operational issues, staffing, resources, system and program needs.
• Manages and completes assigned work plan objectives and projects in a timely manner.
• Participates in committees, task forces, work groups and multidisciplinary teams as needed.
• Maintains professional relationships with provider community and internal and external customers while identifying opportunities for improvement. 
• Oversees staff activities to ensure compliance with regulatory and accrediting standards.
• Conducts self in a professional manner at all times. 
• Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct.
• Acts as an information and problem solving resource for Case Management team members.
• Interacts with medical directors regularly, as necessary.
• Facilitates open and timely communication between team members, other Molina employees and external customers.
• Complies with required workplace safety standards.


Job Requirements

Knowledge/Skills/Abilities

• Demonstrated ability to communicate, problem solve, and work effectively with people.
• Skilled at supervising high functioning teams.
• Able to use effective management principles.
• Excellent organizational skill with the ability to manage multiple priorities.
• Work independently and handle multiple projects simultaneously.
• Knowledge of applicable state, and federal regulations.
 Knowledge of ICD-9, CPT coding and HCPC.
 Knowledge of SSI, Coordination of benefits, and Third Party Liability programs and integration.
 Familiarity with NCQA standards, state/federal regulations and measurement techniques.
• In depth knowledge of CCA and/or other Case Management tools.
• Ability to take initiative and see tasks to completion.
• Computer skills and experience with Microsoft Office Products.
• Excellent verbal and written communication skills.
• Ability to abide by Molina’s policies.
• Able to maintain regular attendance based upon agreed schedule.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
• Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers.




    Jason Edwards
    [Click Here to Email Your Resumé]
    888.411.2228 x 200 - Phone
    407.982.7508 - Fax
    www.NurseResolutions.com


    RN, Registered Nurse, Case Manager, Case Management, Utilization Review, Managed Care, Supervisory, Manager, Management, CCM, CPUR, Sacramento, CA

    Job Snapshot

    Employment Type Full-Time
    Job Type Health Care
    Education Not Specified
    Experience Not Specified
    Manages Others Yes
    Industry Healthcare - Health Services
    Required Travel Not Specified
    Job ID Jason
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    RN - Supervisor of Case Management - Managed Care


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