Job Description
Job Description
Job description
Position Purpose : Conduct and manage the daily operations of the case management function
- Must be an RN
- Must know Managed Care
- Must know TruCare and how it works
- Ensure successful transition of care for members from case management to the utilization management
- Review analyzes of activities, costs, operations and forecast data to determine progress toward stated goals and statistical / financial purposes.
- Develop, implement and maintain compliance with policies and procedures regarding medical case management
- Ensure compliance with federal and state regulations and contractual agreements
- Develop, implement, and maintain case management programs to facilitate the use of appropriate medical resources and decrease health plan financial exposure
Qualifications :
Education / Experience : Bachelor’s degree in nursing or equivalent experience. 4+ years of combined clinical nursing and case management experience.
Familiarity with Medicaid managed care practices and policies, CHIP, and SCHIP. Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.
For Arizona Complete Health - Complete Care Plan :
Education / Experience : Bachelor’s degree in nursing or equivalent experience. or behavioral health related Master's degree.
4+ years of combined clinical nursing and case management experience. Familiarity with Medicaid managed care practices and policies, CHIP, and SCHIP.
Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.
Children’s team - must have experience working with children who have chronic or complex conditions
License / Certification : RN license, Licensed Clinical Social Worker (LCSW), License Masters Social Worker (LMSW) or Licensed Clinical Professional Counselor (LCPC).
Valid driver’s license and automobile insurance. Case Management Certification (CCM) preferred.
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