Manager of Case Management and Intake
About The Position
Our Manager of Case Management & Intake provides leadership and oversight for the case management clinical team and non-clinical Intake team within our Health Plan. This Manager coordinates patient care programs, ensures quality service delivery and manages staff performance and departmental operations. They develop, implement and monitor case management programs, and intake and discharge planning. This Manager of Case Management & Intake collaborates with other Health Services teams to ensure seamless interdepartmental coordination of services. They identify opportunities for improvement of workflows, executes initiatives, is a key resource for internal departments and represents Health Services on cross-functional projects.
Requirements
- Bachelor’s degree in Nursing or equivalent combination of education and experience; including CCM certification.
- Active license as an RN in the State of Wisconsin or a valid multi-state compact license.
- 7 or more years of clinical nursing experience.
- 3 or more years in a senior level or managerial role in managed care Case Management.
- Strong knowledge and understanding of clinical operations, case management and intake processes and procedures.
- Knowledge of current medical practices, trends, and patterns of care.
- Experience with accreditation standards (e.g., URAC) and regulatory compliance.
- Ability to plan, coordinate, implement, and manage projects in a timely and accurate manner.
- Strong analytical, problem-solving, and communication skills.
- Proficiency with Microsoft Office and clinical systems (e.g., imaging and review platforms).
Nice To Haves
- 5 or more years in a senior level or managerial role in managed care Case Management.
- Familiarity with health plan operations, payer/provider relationships, and insurance benefits.
- Health insurance background in Point of Service (POS), Preferred Provider Organization (PPO), or Medicare Supplement) plans.
- Technical experience with word processing, spreadsheets, and proficiency with electronic medical record (EMR) systems and/or other managed care software.
Responsibilities
- Provides day-to-day managerial direction, leadership, and oversight of Case Management clinical staff and non-clinical Intake teams ensuring compliance with all corporate and departmental policies, procedures, work standards, and strategies.
- Oversees clinical functions, provides direction to clinical staff and serves as subject matter expert for questions and difficult case reviews.
- Develops, analyzes and maintains staff daily/weekly production and compliance.
- Ensures CM and Intake production and quality standards are met.
- Works closely with the intake supervisor to monitor department needs and volume of incoming requests.
- Collaborates cross-functionally to develop and implement new Health Services programs and strategies.
- Develops and revises Health Services policies, procedures, and guidelines that direct department processes, continually evaluating to optimize efficiency within departments.
- Evaluates, analyzes, reports, and responds to case management trends in healthcare delivery areas.
- Recommends and implements changes consistent with Health Services objectives of quality care and reasonable cost.
- Represents Health Services on committees and work groups for various intradepartmental presentations related to Case Management and Intake.
- Oversees the maintenance of documentation for internal and vendor authorization processes.
- Assists with configuration, training and implementation of systems (Aerial, Facets, etc.).
Benefits
- Remote and hybrid work options available
- Performance bonus and/or merit increase opportunities
- 401(k) with a 100% match for the first 3% of your salary and a 50% match for the next 2% of your salary (100% vested immediately)
- Competitive paid time off
- Health insurance, dental insurance, and telehealth services start DAY 1
- Professional and Leadership Development Programs
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What This Job Offers
Job Type
Full-time
Career Level
Manager
