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Manager, Case Management

Atlanta, GA 30082

Post Date: 06/18/18 Job ID: 45580 Industry: Operations Manager

This Fortune 500 client is a nation-wide leader in the healthcare services field and they pride themselves on their ability to provide a wide range of government sponsored healthcare programs; including a variety of insurance solutions. Currently, they are seeking a Manager, Case Management to conduct and manage the day-to-day operations of the case management functions.

Position: Direct Hire

Location: Atlanta, GA

Similar Positions: Registered Nurse, Utilization Management Manager, Case Management Specialist, RN

Responsibilities of the Manager, Case Management:
  • Communicate with departmental and administrative staff to facilitate departmental functions
  • Review and analyze progress toward goals for statistical and financial purposes
  • Ensure compliance with federal and state regulations/ contractual agreements
  • Develop and implement different policies and procedures regarding medical case management
  • Develop and implement case management programs to ensure the proper use of medical resources and decrease health plan financial exposure
  • Ensure all members of the case management staff, members, contracted providers, and subsidiaries have constant communication
  • Train staff to enhance their case management skill set

Requirements for the Manager, Case Management:
  • Bachelor s degree in Nursing
  • Must have 3+ years of case management experience 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, CHIP, and SCHIP.
  • Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.
  • Unrestricted RN license in applicable state(s) and valid driver's license and automobile insurance.
  • Case Management Certification (CCM) preferred.
  • Proficient in Excel to include data analysis, pivot tables, V-Look ups and filtering experience is highly preferred.
  • A minimum of 2 years management experience is highly desired.
  • Recent managed care experience is a plus.
  • Applicants must be currently authorized to work in the United States on full-time basis

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