Overview

Leads a Care Management team focusing on managed Medicare and Medicaid for a national health plan. Overseas administrative and clinical duties within the Care Management Program for clinically complex patients with chronic conditions, ensuring effective staff utilization for maintaining high-quality patient care aligned with program goals and mission. Supports the establishment and execution of departmental policies, procedures, workflows, and internal audits to ensure compliance and quality standards. Evaluates program performance to enhance outcomes and works under general supervision. Opportunities for growth and development.

Compensation:

$109,900.00 - $146,500.00 Annual

What We Provide

* Referral bonus opportunities

* Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays

* Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability

* Employer-matched retirement saving funds

* Personal and financial wellness programs

* Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care

* Generous tuition reimbursement for qualifying degrees

* Opportunities for professional growth and career advancement

* Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

What you will do

* Acts as a subject matter expert, supervises, guides, and trains leadership/staff in program administration to ensure prompt reimbursement and adherence to governmental, regulatory, and contractual standards. Manages and oversees diverse program components (e.g., case assignment protocols, program evaluations, liaison tasks, staff scheduling) to ensure the program operates efficiently. Conducts regular supervision meetings with Team Supervisors.

* Collaborates with Program Director in the development/revision of new and existing clinical and administrative policies and procedures. Prepares policy and procedure manuals; implements, maintains and communicates new/established policies and procedures to staff.

* Develops and implements tools (e.g., surveys, tracking tools) to gather data and track status of current/graduated client for utilization review, quality assurance and evaluation of overall effectiveness of the program.

* Provides data insights to help drive strategic and tactical business opportunities. Gathers, tracks and analyzes data (e.g., client/program demographics, specific targets) to evaluate client status, progress, outcomes and program effectiveness. Develops standard and ad hoc reports to identify trends and project future needs for management use and/or for submission to customers/governmental agencies.

* Assists leadership in, monitoring and analyzing the budget to ensure program needs/expenses are met. Projects and allocates resources (e.g. salaries, supplies, operational needs) and drafts proposals for management's review/approval for requests for additional/changes in funding.

* Plans, coordinates and chairs regularly scheduled staff meetings and case conferences.

* Identifies and assesses intra-team problems through observation, file review and patient/staff feedback. Suggests resolutions to problems, including additional training and/or counseling of team members.

* Performs all duties inherent in a managerial role. Manages the day-to-day activities of the program, establishes workflows and protocols, assesses effectiveness, and makes recommendations for improvements as needed. Ensures effective staff training, evaluates staff performance, provides input for the department budget, and hires/promotes/terminates staff and recommends salary actions, as appropriate.

* Participates in special projects and performs other duties as assigned.

Qualifications

* Bachelor's Degree Relevant degree needed for professional licensure: Nursing,

* Master's Degree In nursing, business, healthcare or related field preferred

* Minimum of five years of clinical experience as a Registered Nurse required

* Experience in case management, care coordination of social services or discharge planning experience in a hospital setting required

* Minimum of four years of progressively responsible supervisory/managerial and administrative experience in a health care setting, or social services setting with demonstrated competency in program administration, budget management and community relations required

* Experience in managed care environment preferred

* Excellent oral, written, and interpersonal communication skills required

* Proficient PC skills, including Microsoft Office required

* License and current registration to practice as a registered professional nurse