Supervisor Case Management

First Choice Health•Seattle, WA

About The Position

POSITION SUMMARY: The Supervisor for Case Management (CM) supports the Manager of Case Management in providing leadership and oversight for the Case Management (CM) Department. Provides direct supervision of the medical Case Managers. Develops and maintains strong working relationships with payers, brokers and internal departments for PPO/TPA services. Supports quality management and accreditation activities; complies with HIPAA and ERISA standards. ABOUT FIRST CHOICE HEALTH: First Choice Health, headquartered in Seattle, WA, is a provider-owned healthcare organization offering employers a forward-thinking alternative to traditional health insurance. We have been serving employers of all sizes and across many industries with exceptional health benefits administration for over 35 years, providing unparalleled access to a growing number of clinically integrated networks (CIN) and a traditional PPO. Alongside our Employee Assistance Program (EAP) addressing mental health and work-life balance, our services collectively support members in every step of their healthcare journeys. At First Choice Health, we are proud to deliver the personalized, quality service our clients deserve, while reducing costs and keeping their members healthy. OUR PURPOSE, VALUES & CULTURE: Uniting providers, employers, and individuals, we deliver sustainable solutions that elevate the health and care of our communities. CARE TRANSPARENT COLLABORATE RELENTLESS INNOVATE We strive to uphold the above values and take steps to cultivate our culture through each one. We work as a community, guided by our values and are unified in our mission to make healthcare access easier for everyone from all walks of life. Learn more about how we foster a culture of belonging. At First Choice Health, we believe that a culture that fosters belonging- one that accept employees for who they are, nurtures creative thinking, and appreciates different perspectives drives our success. By cultivating an environment where every voice is valued, we empower our employees to bring their best selves to work, enable us to serve our clients and communities more effectively. We work as a community, guided by our values and are unified in our mission to make healthcare access easier for everyone from all walks of life.

Requirements

Current unrestricted RN license required. Bachelors (or higher) degree in a health-related field preferred; ability to obtain additional state licensure where requested within 1 year of hire.
Certification as a case manager or must obtain certification as a case manager within two years of hire.
Minimum three years of Case Management experience with strong written and verbal communication skills.
Strong organizational and time management skills.
Proficient computer skills.
Minimum three years experience in an HMO/ health care industry.
A solid knowledge of case management and utilization management.

Nice To Haves

One year of management experience is preferred.

Responsibilities

Provides direct oversight and clinical / administrative leadership in conjunction with the Manager of Case Management (CM Manager) to the medical Case Management team.
Works with the CM Manager to assure that all regulatory, accreditation and FCH Policy requirements are met.
Collaborates with CM Manager to implement all new case management programs, and continue with current programs.
Reviews and revises case management policies and procedures, and creates and updates desk procedures in conjunction with the CM Manager and MM Director.
Ensures Case Management operations and documentation adhere to regulatory standards.
Coordinates and collaborates with leadership in the department regarding PPO/TPA Case Management activities.
Collaborates with the CM Manager to maintain staffing levels according to enrollment and designated departmental functions. Monitors CM productivity.
Conducts Case Management audits and IR-R, and shares results with staff in a timely manner.
In conjunction with the CM Manager is responsible for CM Quality Improvement Projects.
Works with the CM Manager to ensure compliance of departmental standards.
Participates in interviews and hiring of new staff. Works with Case Management Trainer to ensure new employees are oriented and obtain the job training necessary to their position. Assures compliance with annual training.
Maintains open communication with internal and external customers, especially payers and consultants/brokers.
Develops a positive working relationship with Marketing and PPO network departments to enhance the implementation of new groups.
Other duties as assigned.

Benefits

Medical & Vision- We offer two medical plans for employees, High Deductible and PPO plan for employees to choose from.
Dental- A dental plan through Delta dental is available to employees and eligible dependents.
Health Savings Account (HSA)- Employees who enroll in our medical plan can choose to establish a health savings account if eligible. FCH makes contributions to the HSA and employees may contribute pre-tax dollars via payroll deduction up to the IRS allowable limits.
Flexible Spending Account (FSA)- Employees may contribute pre-tax dollars through payroll deduction to a limited vision/dental FSA. Unlike with an HSA, unused FSA funds do not rollover from year to year
Life Insurance- FCH provides life insurance benefits at no cost at a limit of two times an employee’s annual base salary (with a max of $300,000). Employees have the opportunity to purchase additional life insurance for themselves and their dependents through payroll deduction.
Short & Long-Term Disability Insurance- FCH provides long-term and short-term disability coverage to all employees. It is a shared cost benefit where FCH pays for the long-term benefit and employees pay for the short-term benefit.
Personal Leave and Sick Time- FCH employees enjoy the benefit of paid time off. Vacation, sick leave, and any personal leave are combined into a general annual PTO bank. PTO accruals are based on service on a pay period: 0-1 year of service – 120 hours; 1-2 years of service – 136 hours; 3 + years of service – 168 hours.
Paid Holidays- Each employee receives 13 paid holidays. 16 hours per year are available for community services, usable in four-hour or eight-hour time blocks.
Employee Assistance Program (EAP)- FCH recognizes that a variety of problems can disrupt personal and work life. If an employee needs professional help, they can contact the EAP, which provides confidential access to professional counseling services for help in confronting personal problems such as alcohol/substance abuse, marital and family difficulties, financial or legal troubles, or emotional distress.
Retirement Plan 401(k)- We contribute 50% of the employee’s 401k deferral , up to a maximum of 3% of the employee’s gross salary. Eligible employees must be at least 21 years old, and be employed with FCH a minimum of 90 days.
Profit Sharing - FCH may make annual discretionary profit sharing contributions in an amount to be determined at Plan Year end.
Tuition Reimbursement - Employees may be eligible to receive reimbursement for continuing education for Bachelor’s program after one year of employment with the company.
Wellness- We encourage and promote healthy behaviors through a Wellness program that offers rewards for those that participate.