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Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work.(sm)The Manager of Case Management is responsible for facilitating communication and directing the operations of all Case Management programs in a defined market. The Manager leads the market staff on all activities related to medical management initiatives including changes in process, staffing or care delivery model. Additionally, the manager ensures compliance with all state/federal regulations and NCQA/URAC standards. The Manager collaborates with the Market Director of Case Management, medical directors, PCPs, clinic and corporate medical management leadership on care coordination activities.Primary Responsibilities:Supports case management operations across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating)
Oversees care management functions and ensure compliance with application of criteria from approved standardized guidelines, government mandated regulations and contractual agreements, to include NCAQ, URAC, and CMS
Engages in Care Team forums/meetings to support care coordination activities between the market providers and the case management team
Plans, organizes and oversees staff to ensure timely completion of um determinations, discharge planning and case management assessments
Ensures team meets established performance metrics and medical cost reduction goals. Includes timely reporting of monthly KPIs
Adapts departmental plans and priorities to address business and operational challenges
Oversees the team’s daily staffing requirements to meet program standards
Implements and interprets organizational policies and procedures, reviews work of staff to ensure that policies and guidelines are appropriately applied
Tracks and trends outcomes for potential improvements in the care management process
Creates monitors, evaluates and disseminates program and productivity reports weekly, monthly, and as needed
Interviews, hires, and retains staff to meet the needs of the department
Evaluates staff performance and recommend merit increases, promotions, and disciplinary actions
Attends, and assists with the facilitation of local market intra-disciplinary care team meetings
Monitors and oversees the reporting of all quality issues to medical management leadership for referral and reporting to health plans as appropriate
Monitors appropriate utilization of resources, overtime, supplies and mileage
Perform comprehensive assessments and document findings in a concise/comprehensive manner that is compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations
Performs all other related duties as assigned
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.Required Qualifications:Bachelor of Science in Nursing (BSN) required (4 additional years of experience beyond the required years of experience may be substituted in lieu of a bachelor’s degree)
Current unrestricted RN license in the applicable state required
CCM certification or completion of CCM certification within 1 year of hire date
3+ years of Care Management experience to include experience in a managed care setting, hospital setting, Skilled Nursing facility and/or physician practice setting
3+ years of demonstrated supervisory or management experience with responsibility for team performance management
Ability to establish and maintain effective working relationships with employees, managers, healthcare professionals, physicians and other members of senior administration and the general public
Data mining, analytical and reporting skills required. Ability to review and interpret data to make recommendations to senior-management
In and /or out-of-town travel required as deemed necessary by business need
Solid experience with MS office including Word, Excel and Outlook with proficient ability to navigate in a Windows environment
This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor's diagnosis of disease
Preferred Qualifications:Master’s Science in Nursing
Prior multi-site regional operations management responsibility
Strong organizational skills and multitasking abilities
Physical & Mental Requirements:Ability to sit for extended periods of time
Ability to use fine motor skills to operate office equipment and/or machinery
Ability to receive and comprehend instructions verbally and/or in writing
Ability to use logical reasoning for simple and complex problem solving
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.Job Keywords: RN Manager Care Management, Austin, TX, Texas
