Supervisor, Case Management

Imagine360 • ,

4d • Remote

About The Position

Imagine360 is seeking a Supervisor, Case Management. The position provides supervision to Case Managers and delivers case management services under group health plans, drawing on nursing education and supervisory, clinical, and professional experience. The role is 100% remote and includes day-to-day team management, quality and performance oversight, employee development, and coordination with internal and external stakeholders. The position must be performed in accordance with applicable licensure and certification scope, HIPAA/PHI requirements, Department of Labor and ERISA rules, and department and company policies.

Requirements

• Nursing degree from an accredited college, university, or school of nursing.
• At least 3 years of experience in a clinical role with direct patient-care responsibilities.
• Experience in Utilization Management, Case Management, or transferable clinical experience and skills.
• Experience mentoring or managing a team of clinical or non-clinical staff.
• Active, unrestricted Registered Nurse license in an eNLC compact state.
• Maintain continuing education units as required by applicable State Board(s) of Nursing and required certifications.
• Willingness to obtain and maintain additional licenses as required for the organization's job functions.
• Ability to work independently in a home office environment.
• Proficiency with Microsoft Outlook, Word, Excel, and PowerPoint, and internet navigation.
• Ability to resolve problems independently and multitask.
• Strong written, oral, and telephone communication skills.
• Strong presentation skills.
• Commitment to building new skills and fostering a positive work environment.
• Organizational, problem-solving, analytical, and detail-oriented skills.
• Ability to prioritize workloads, multitask, and manage priorities to meet deadlines.
• Ability to maintain protected health information confidentiality in compliance with HIPAA.

Nice To Haves

• Bachelor's degree in nursing.
• Experience working in a URAC-accredited Case Management program.
• Experience working within an insurance agency or TPA specializing in employee benefits and self-funded medical plans.
• Certified Case Manager (CCM) designation. Candidates who do not have the designation will be required and supported to obtain it within 12–24 months of hire.

Responsibilities

• Collaborate with the Manager, Case Management to edit, maintain, and implement policies and procedures that meet applicable accreditation requirements and business needs.
• Provide oversight and education to Case Managers on case management and medical necessity review.
• Review and audit monthly Case Manager billing.
• Support Quality Program initiatives through data collection, reporting, and employee training.
• Maintain and report satisfaction survey results.
• Research member complaints and provide resolutions.
• Participate in interviews and onboarding for new employees.
• Establish orientation schedules, coordinate training, and participate in new employee training as directed.
• Oversee and evaluate employee caseloads based on eligibility criteria, member needs, and employee qualifications.
• Monitor employee schedules and PTO coverage to meet business needs.
• Manage the team's day-to-day performance and provide mentoring and coaching as needed.
• Lead projects that improve service delivery.
• Complete and report quality assurance reviews, call audits, and chart audits of Case Managers.
• Lead, attend, and participate in one-on-ones, team meetings, trainings, and other job-specific events as required.
• Communicate in compliance with HIPAA with brokers, vendors, Relationship Managers, HR representatives, and stop-loss contacts as needed.
• Communicate professionally and effectively.
• Staff complex cases with the Manager, Case Management or Senior Manager, Patient Care Services.
• Follow internal regulations regarding the Department of Labor, HIPAA, ERISA, and department and company policies and procedures.
• Complete annual HIPAA training and perform all tasks in accordance with HIPAA/PHI guidelines.
• Escalate difficult issues appropriately.
• Perform duties in accordance with the scope of licensure and certifications held or required.
• Perform other duties and projects as assigned.

Benefits

• Multiple health plan options.
• Company-paid employee premiums for disability and life insurance.
• Parental Leave Policy.
• 20 days of PTO to start and 10 paid holidays.
• Tuition reimbursement.
• 401(k) company contribution.
• Company-paid short- and long-term disability and life insurance.
• Professional development initiatives and continuous learning opportunities.
• Opportunities to participate in and support the company's diversity and inclusion initiatives.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Education Level: Associate degree