Job Details
Job Description
In need of an RN with case management experience.
Primary Responsibilities:
- Selects, manages, develops, mentors and supports staff in designated department or region
- Develops clear goals and objectives for performance management and effectively communicates expectations, and holds the team accountable for results
- In order to meet the unique needs of our members, have an intimate understanding of the contractual requirements
- Identify, select, structure, and prioritize process improvement projects, ultimately implementing changes to meet program requirements
- Ensures standardized execution of workflow processes, including conducting performance audits, quality reviews, and compliance adherence
- Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care
- Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services
- Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
- Advocate for patients and families as needed to ensure the patient s needs and choices are fully represented and supported by the health care team
- Participates in training and coaching of direct reports as needed
- Conducts bi-annual field visits with direct reports to observe, provide areas of teaching, address issues and concerns and foster a good working relationship
- Collaborates across Optum and UHG and interacted with Medical Directors, Site Directors, Senior Leaders, Network, Marketing, Account Management, Quality, Product, and other stakeholders
Required Qualifications:
Resident of Indiana
BSN or BSW with equivalent experience
Registered Nurse with an unrestricted License in Indiana
Experience working within the community health setting in a health care role
Experience or knowledge of Indiana Medicaid, Medicare, Long term care
Experience coaching or mentoring staff
Intermediate level of experience with Microsoft Word, with the ability to navigate a Windows environment
Preferred Qualifications:
3+ year of case management leadership experience within a healthcare industry
Background in managed care
Case Management experience
Certified Case Manager (CCM)
Experience / exposure with members receiving long term social supports
Experience in utilization review, concurrent review and/or risk management
Company Description
Professional Management Enterprises is a minority and veteran owned business that partners with major healthcare providers to find quality employees and thrives on helping people find positions that exceeds their expectations.
Professional Management Enterprises is a minority and veteran owned business that partners with major healthcare providers to find quality employees and thrives on helping people find positions that exceeds their expectations.