RN Case Management Manager

Gonzaba Medical Group•San Antonio, TX

11d

About The Position

The Case Management Manager will be responsible for oversight of the High-Risk team and the Case management team by managing performance metrics, conducting audits, and maintaining staff trainings. Ensures timely care plans are developed and implemented to optimize patient outcomes and utilization management.

Requirements

Graduation from an approved LVN or RN program.
Must be state-licensed LVN or RN with a minimum of three years of LVN or RN experience, clinic experience preferred.
Must have prior medical terminology.
Must have excellent customer service skills.
supervisory experience.
Must have a minimum of 2 years of leadership experience in Managed Care.
RN and IV certifications are required.
Computer Skills: Skilled in use of computer/EMR systems.
Knowledge of Word processing software, spreadsheet software, Internet, and database software.
Requires manual dexterity, sitting, standing, stooping, reaching, kneeling, crouching, bending, walking, lifting up to 40 lbs. without assistance.
Close vision and ability to adjust focus.
Must be able to work efficiently under pressure.

Nice To Haves

Prior managed care experience preferred.

Responsibilities

Directs day-to-day departmental activities including scheduling, staffing and oversight of daily operations.
Coordinates work schedules, coverage plans and assignments for Case Management/High Risk Team (CM/HR).
Participates in defining annual departmental goals/objectives and takes responsibility for their achievement.
Effectively engages CM/HR staff in accomplishment of goals.
Assists with hiring, training, on-going supervision, discipline, and evaluation of staff.
Helps provide a comprehensive orientation and staff development program.
Provides timely feedback and staff evaluations.
Ensures that CM/HR team supports effective Patient Care Committee, High Risk and Small Group Meetings.
Ensures that CM/HR staff maintains strictest member and company confidentiality; ensures member health information is secured each day; Demonstrates HIPAA knowledge and focus
Identifies opportunities for operational improvement and works collaboratively with the CM/HR team and other GMG staff.
Communicates effectively with clinic staff, internal providers, patients, and external providers regarding CM/HR matters.
Monitors the status of work, via reports, flags, phone calls, and other means.
Facilitates the process to ensure timely service to patients and providers.
Reviews and monitors the work performed and documentation in Electronic Medical Record (EMR) to evaluate knowledge, skills, quality of care and appropriateness of documentation.
Ensures that Census, Radar Report, Bed Days report and High-Risk Patient Status are completed accurately and distributed in a timely manner.