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