RN Supervisor of Case Management

Location: Buffalo, NY
Date Posted: 08-01-2018
RN Supervisor of Maternity Case Management - Health Plan
Buffalo, NY (northeast suburb, near Getzville)
Supervisor of Case Management Job Summary: 
  • Supervise the day-to-day activities of a unit of employees engaged in case management activities. 
  • Identifies the need for and participates in the development and implementation of Care Management and Utilization Management policies and procedures and ensures compliance to promote cost-effectiveness and improved quality. 
  • Communicate effectively and functions as liaison between nurse and physician reviewers, medical directors, coordinators, PCP and specialist providers, regarding any UM or referral authorization issues, as well as care coordination issues.
  • Assist with the training of new requirements from state and federal regulations, health plan policy shifts, and corporate improvements
  • Assist with new referrals, chart auditing, and unique situations as necessary.
  • Communicates appropriately and clearly to management, co-workers, and physicians.
  • Interacts professionally with the patient, their family and their physicians and involves them in formation of the plan of care.
  • Documents patient assessment and reassessment, patient care plans, and other pertinent information completed in the patient’s medical record in accordance with nursing standards and policies.
  • Identifies community resources to address needs to cover through patient’s benefit plans.
  • Identifies non-compliant members eligible for health plan dis-enrollment.
  • The specific focus of this position / department is members receiving maternity care, treatment, and planning.

Supervisor of Case Management  Background: 
  • Current unrestricted state Registered Nurse (R.N.) license.
  • Prefer Bachelor of Science in Nursing (B.S.N.) or related field. 
  • Certification in Case Management, such as CCM is a plus.
  • Around 2-3 years’ experience in direct clinical care in acute care provider environment.
  • At least 2-3 years’ prior Case Management and Disease Management experience in a managed care setting (HMO, IPA, Health Plan, or TPA). 
  • Prefer (but does not require) around 1-2 years’ experience with nursing issues as they relate to maternity / pregnancy / childbirth (prenatal / perinatal / postnatal).
  • Around 3-4 years’ experience as a supervisor, or relevant experience leading and managing teams.
  • Knowledge of guidelines for Medicaid/Medicare and related state programs is required.
  • Knowledge of InterQual/Milliman criteria and other guidelines for medical necessity, setting and level of care, and concurrent patient management.
  • Knowledge of health care delivery system, utilization review and case review procedures.
  • Computer skills to include Microsoft Word, Excel and basic data entry.
  • Strong oral and written communication skills; ability to interact within all levels of the organization and with external contacts.
480.269.9491 (CALL – TEXT – FAX)
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