Manager, Case Management

Imagine360•,

1d•Remote

About The Position

Imagine360 is seeking a Manager, Case Management to join the team! The Manager, Case Management will utilize education, clinical expertise, management experience, and a strong program leadership approach to lead the Case Management service area of the Medical Management department. The Manager, Case Management, is pivotal in ensuring the delivery of high-quality case management services while driving excellence in program outcomes through effective program and project management, data-informed decision-making, innovation, and transformation. The Manager of Case Management is expected to possess strong leadership skills, clinical expertise, an analytical mindset, and a commitment to improving patient care through effective management and collaboration, while maintaining compliance with the Registered Nurse Scope of Practice.

Requirements

A bachelor's degree in nursing from an accredited school of nursing, or years of experience in lieu of degree will be considered.
5+ years' experience in Case Management or related field.
3+ years' management experience in Case Management or a health-related field, experience leading teams of RNs or other licensed employees.
3+ years' experience working in a URAC accredited Case Management program.
Experience leading teams of Supervisors, and proven success in achieving program goals.
Experience leading program or project initiatives, including planning, implementation, stakeholder coordination, change management, communication planning, risk management, and outcome measurement.
Experience using data, analytics, dashboards, scorecards, audit results, quality outcomes, and performance metrics to assess program effectiveness and inform operational or strategic decisions.
Current, active, and unrestricted compact Registered Nurse license.
Must maintain CEU's as required by the State Board of Nursing.
Must be willing to obtain and maintain additional license(s) as required to perform the job functions of the organization.
Basic knowledge and skills using Microsoft Office including Word, Excel, and PowerPoint software; Internet software; Database software.

Nice To Haves

Experience leading clinical program transformation, process improvement, or operational redesign initiatives.
Experience developing or using dashboards, scorecards, reporting tools, or analytics to monitor program performance and outcomes.
Project management, Lean Six Sigma, change management, or process improvement experience preferred.
Experience supporting accreditation readiness, quality improvement initiatives, corrective action planning, or regulatory response activities preferred.
Current Certified Case Manager (CCM) Certificate preferred; if Certification is not current, employee must pursue and achieve CCM Certification within three years of employment.

Responsibilities

Provide visionary leadership and mentorship to the Case Management Team, fostering a culture of excellence and continuous improvement.
Lead program strategy, planning, implementation, and ongoing optimization to ensure Case Management programs meet organizational, clinical, quality, and accreditation goals.
Champion innovation, transformation, and change management initiatives that improve operational effectiveness, member outcomes, staff engagement, adoption, and program scalability.
Provide supervision and deliver comprehensive training, resources, and mentoring to ensure team adherence to Case Management standards per URAC.
Managing staff performance
Communicating updates about organizational process and changes affecting case management staff
Providing training opportunities for continuing education and development
Providing current resources for case management staff to maintain knowledge, skills and competencies for their role
Acting as a resource for staff during the case management process.
Leadership, mentorship, and direction to Case Management Supervisors and the team to achieve program goals.
Manage and participate in interviewing, recruiting, and overseeing new hire processes and employee evaluation processes.
Evaluating effectiveness of training, coaching, and team retention strategies
Maintain and oversee time and attendance for designated employees, as needed.
Develop, maintain, and communicate Case Management Policies and Procedures tailored to each program, with ongoing monitoring to ensure staff compliance.
Oversee and ensure consistency in program delivery for Case Management orientation and training plans, across all teams.
Participates in Quality Management program and Accreditation adherence in the following ways: Member of the Quality Management Committee (QMC).
Leads quality management initiatives as an active member of the QMC.
Is a liaison between the Quality Management Committee and the employees.
Collaborate with Medical Management's Quality Management team to submit reports on policies and procedures requested for quality initiatives and applicable URAC standards and reporting measures.
Implements training and measures outcomes pertaining to quality as it relates to the case management activities.
Proposes policy and procedure (P&P) changes to the Medical Management leaders and the Quality Management Committee to enhance program efficiency and quality.
Oversees Quality Assurance review processes, ensuring high standards of service delivery within the team.
Manage new hire and employee Quality Assurance and evaluation processes.
Track and respond to internal and external feedback regarding Case Management services and employees, ensuring continuous improvement.
Continuous research and implementation of industry best practices to drive innovation and excellence in the Case Management program.
Develop, monitor, and evaluate key program metrics, dashboards, scorecards, and performance trends to support program accountability, best-in-class delivery, and measurable outcomes for members and clients.
Lead cross-functional projects with Medical Management, Quality, Operations, Account Management, Compliance, and data/technology partners to advance program priorities and outcomes.
Apply project management principles to plan, execute, monitor, and sustain program initiatives, including timelines, deliverables, stakeholder engagement, risks, dependencies, communication plans, and outcomes.
Use data, reporting, root cause analysis, and trend analysis to identify opportunities, evaluate program performance, inform improvement plans, and drive measurable improvements.
Responsible for leading all Accreditation processes, standards, and requirements within the Case Management programs.
Own Case Management URAC accreditation, ensuring proper auditing, processes, policies, and procedures are adhered to.
Responsible for reaccreditation processes for Case Management
Lead the team and implement systems and processes that drive continuous quality improvement activities and accreditation requirements.
Ensure compliance with imagine360 Policies and Procedures, internal Medical Management Policies, Department of Labor, ERISA, and HIPAA regulations.
Collaborate with Medical Management Account Management to provide reports and updates to Relationship Managers and clients.
Communicate effectively with brokers, vendors, Relationship Managers, HR representatives, and stop-loss providers, maintaining compliance with HIPAA
Review, audit, and verify monthly billing hours from Case Management teams
Complete annual HIPAA training and adhere to HIPAA/PHI guidelines.
Perform other duties and projects as assigned.
Evaluating clinical data
Assessment and evaluation of the acquired clinical date to assess the appropriateness of treatment based on Medical Management clinical guidelines.
Coordination of treatment plans, interventions, and outcome measurement
Rationale for the effects of medication and treatments
Provide patient education and educational resources.
Accurately report: Administration of medication and treatments
Client response
Contact with other health care team members.
Respect the client's right to privacy by protecting confidential information.
Promote and participate in education and counseling to a participant based on health needs.
Clarify any treatment believed to be inaccurate, non-efficacious, or contraindicated by consulting with appropriate practitioner.

Benefits

Multiple Health plan options
Company paid employee premiums for disability and life insurance
Parental Leave Policy
20 days PTO to start
10 Paid Holidays
Tuition reimbursement
401k Company contribution
Company paid Short & Long term Disability plus Life Insurance
Professional development initiatives / continuous learning opportunities
Opportunities to participate in and support the company's diversity and inclusion initiatives