RN Supervisor of Case Management

Location: Tempe, AZ
Date Posted: 11-01-2018
CareNational
RN Supervisor of Case Management - Health Plan 
Tempe, AZ 
 
RN Supervisor of Case Management Duties: 
  • 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.
  • Sets the example for the team by following through with requests, sharing of critical information, returning phone calls and getting back to individuals in a timely manner.
  • Works with the managers and directors to prepare the department for accreditation surveys using appropriate standards of performance.
  • 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.
  • Ensures that the nurse case managers demonstrate the ability to formulate an appropriate outpatient care plan, based on a telephonic assessment of patients’ needs and symptoms which addresses all key symptoms in order to effectively manage the patient on an outpatient basis.
  • Provide motivation and encouragement to subordinates, conduct performance evaluations and monthly reviews, identify and coordinate training needs, make determinations regarding disciplinary actions.
  • Provides oversight of staff duties as described in accordance with direction from department leadership.
 RN Supervisor of Case Management Background: 
 
  • Current unrestricted state Registered Nurse (R.N.) license.
  • Prefer Bachelors of Science in Nursing (B.S.N.) or related field. 
  • Certification in Case, Utilization, or Quality Management, such as CCM, CPUM, or CPHQ, is preferred.
  • Around 2-3 years’ experience in direct clinical care in acute care provider environment.
  • At least 2-3 years’ prior Utilization or Case Management experience in a managed care setting (HMO, IPA, Health Plan, or TPA). 
  • Roughly 1-3 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.
 


RN Supervisor of Case Management Reward:  

EXCELLENT BENEFITS AND HIGHLY COMPETITIVE SALARY OFFERED!
This growing organization is committed to the health and happiness of all their staff. They offer a comprehensive benefits package to all full-time, permanent employees including Medical, Dental, and Vision insurance, 401(k) (w/ a 1% company match), Life and Disability insurance, Flex Spending Accounts. Multiple plan options for each Medical, Dental, Vision, including some Medical plans that are 100% FREE for employees! Benefits begin on Day 1 of employment. Forward-thinking ‘Adult’ PTO program (virtually unlimited PTO). Catered Lunches Monday, Tuesday, and Thursday; Catered Breakfast on Fridays; and paid dinner for those working late! Additional benefits include: Health/Wellness budget ($50/month); Employee Assistance Program; Pre-Tax Commuter Benefits; Educational Reimbursement up to $5,250/year; and much more!

#CLINICAL
RON AMODIO
STRATEGIC DIRECTOR
CareNational
ron@carenational.com
480.269.9491 (CALL – TEXT – FAX)
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