RN Mgr, Care Management

Summa Health•Akron, OH

53d•$41 - $62•Hybrid

About The Position

We are seeking an experienced (RN) Nurse Manager to lead our Care Management Team working with members and families with a variety of complex healthcare needs. Prior Care Management experience required. Previous health plan experience helpful. The role would be hybrid once acclimated, with one day a week onsite and occasional onsite for training or meetings. Summary: Hybrid Home/Office presence needed to meet organizational, operational and service goals related to quality outcomes, member experience, and cost-efficiency. Plans, implements and manages Health Services Management activities for members needing a medium-to-high intensity of outreach and coordination, and a wide variety of supportive services in order to meet organizational goals related to quality outcomes, member experience and cost-efficiency. Perform duties to conduct and manage the day-to-day operations of the care management functions. Communicate with staff to facilitate daily department functions including member/network navigation and population outcomes/goals for a variety of age groups and health care needs. Promotes coordination of members to clinically appropriate settings, and appropriate referrals to SummaCare programs. Overtime during peak periods is possible. Rare need for weekend availability/support. Occasional travel to attend meetings, conferences, workshops, and/or seminars.

Requirements

Registered Nurse (RN) state license in good standing required.
Three (3) years performing care management/population management or like activities. Relevant experience includes: clinical nursing and health plan management, working knowledge of Medicare and/or Commercial plan designs, and experience with clinical regulatory and accrediting guidelines
Prior management/leadership experience
Moderate computer skills and familiarity with Outlook, Word, Excel, PowerPoint
Ability to travel from location to location throughout the workday.

Nice To Haves

Bachelor's Degree or equivalent combination of education and/or experience preferred
Case Management Certification (CCM, ACM) preferred
Previous health plan experience helpful.
Knowledge of Epic helpful
Knowledge of Interqual or MCG helpful
Knowledge of CMS, NCQA, a/o ODI requirements helpful for health plans.
Population Specific Competency: Ability to effectively interact with patients/customers with the understanding of their needs for self-respect and dignity

Responsibilities

Plans, implements and manages Health Services Management activities
Conduct and manage the day-to-day operations of the care management functions
Communicate with staff to facilitate daily department functions including member/network navigation and population outcomes/goals for a variety of age groups and health care needs.
Promotes coordination of members to clinically appropriate settings, and appropriate referrals to SummaCare programs.