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Manager of Care Management

Seattle, WA



The Manager of Care Management is a full time position, responsible for assisting the Director of Medical Care Management in the day to day management of operational, clinical and functional support for the following programs:


Enhanced Concurrent Review - Medical Utilization Management, The Manager supervises staff in multiple locations including remote or telecommuter staff.. Responsibility for hiring, coaching and completion of performance evaluations. Assists with policy and procedures, accreditation and regulatory standards. Offers input and works with the appropriate departments to support
the development and launch of new and existing programs, reporting and/or technology; Works with our internal and external clients to deliver quality products and provide excellent customer service.


Education/License/Certification


Licensed RN with current, unrestricted license required
Bachelor's degree preferred in a health science


Experience


Two-three years clinical experience in care management or acute hospital discharge planning required.
Three years full-time direct clinical or critical care to patients in a medical/surgical setting.
5 years experience in Triage or Utilization Management or Case Management, and/or other managed care or cost management program.
At least 5 years Call Center Management experience preferred.
Experience with application of healthcare criteria systems and programs, e.g. Triage, InterQual, Milliman, CMS.
Must have previous experience with URAC and or NCQA accreditation process.


Knowledge/Skills


Ability to manage and coordinate programs, projects, resources, and staff across multiple company functions;
Strong administrative qualities to analyze goals, products, programs, and processes and make recommendations for changes;
Knowledge of all aspects of the following managed care products: utilization management, case management, disease management and triage;
Organizational and project management skills;
Experience working with clinical documentation programs designed for case management, disease management, utilization management and triage programs;
Strong computer skills and experience with Microsoft Office;
Strong communication, interpersonal and leadership skills.


Job Performance/Responsibilities


Coordinates and manages all Medical Utilization Management, Case Management, and Nurse Triage programs.
Assure job descriptions and staff roles/responsibilities are accurate and current
Responsible for supervision and oversight of staff
Supervise the interviewing and hiring of staff and supervisors for the above programs;
Assist in the licensing and accreditation process for all programs;
Assure that all regulatory and accreditation standards are implemented and met;
Assure that Policies & Procedures, Operational Guidelines, and process workflows are current meet quality accreditation and regulatory standards, and are communicated to and available for staff on the IntraNet;
Develop annual Workplan & Evaluation for each program in conjunction with the QI committee (includes goals, objectives, and planned new processes/enhancements) and communicates the Annual Workplan and previous year's Summary to Senior Management and staff;
Assist the Quality department in the development and evaluation of an annual QI plan for all programs and assures all indicators are met;
Participate in the Quality Committee and assists in related functions;
Analyze all programs to ensure effectiveness, quality, productivity, profitability and patient safety;
Coordinate all programs and work with other Health Integrated Departments and Committees, i.e. Quality Committee, Education, Account Management, etc;
Assist in new product development efforts and assures current products are being delivered as designed;
Assist the Director in plans for growth;
Provide input and direction to Information Services on systems issues and enhancements;
Offer input and assist with development of orientation, education and training programs
Assure delivery expectations of client contracts are being met;
Assist in the development of management reporting capabilities and works with supervisors to ensure they understand and use them to effectively manage the delivery of services; and provide required reports and special projects as needed.
Ensure clinical staff consult and seek advice from a licensed physician with expertise appropriate to the types of services being managed


Please direct all inquiries to David Mara at (804) 402-8088 or e-mail at dmara@nexushc.com. For more information about Nexus Healthcare go to www.nexushc.com