Manager, Case Management

(Job Id W329391)
Posted on 3/4/2010
Location:

Columbia, SC


Job Type:

Full Time


Salary: $60000.00 to $74000.00/year
Degree: Bachelor
Job Description
Manager, Case Management

Perform duties to conduct and manage the day-to-day operations of the case management functions communicating with departmental and plan administrative staff to facilitate daily department functions.

Position Responsibilities:

Review analyzes of activities, costs, operations and forecast data to determine progress toward stated goals and statistical/financial purposes.Promote compliance with federal and state regulations and contractual agreements. Develop, implement and maintain compliance with policies and procedures regarding medical case management.Develop, implement, and maintain case management programs to facilitate the use of appropriate medical resources and decrease health plan financial exposure.Facilitate on-going communication between case management staff, members, contracted providers, and subsidiaries. Develop staff skills and competencies through training and experience.

Knowledge/Experience:
Bachelors degree in nursing or equivalent experience. 3 5 years 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.

Bachelors degree in health related field and Certified as a Case Manager or Professional certification in a clinical specialty, Certified as a Case Manager and 3 years of experience as a case manager.

Plus 3 5 years case management experience. Thorough knowledge of case and/or utilization management and clinical nursing. Familiarity with Medicaid managed care practices and policies.

Licenses/Certifications: Current registered nurse in applicable state(s) and state drivers license and automobile insurance. Case Management Certification (CCM) preferred.