Imagine360 is currently seeking a Supervisor, Case Management to join the team! The Supervisor, Case Management is responsible for providing supervision to Case Managers and case management services under the group health plans by utilizing their nursing education, supervisory, clinical, and professional experiences.
Position Location : 100% Remote
Supervisory Responsibilities :
- Oncology and Hematology / Oncology RN Case Managers
- Team Lead
Duties / Responsibilities :
Provide supervision and deliver comprehensive training, resources, and mentoring to ensure team adherence to Case Management standards per URAC.Managing staff performanceCommunicating updates about organizational process and changes affecting case management staffProviding training opportunities for continuing education and developmentProviding current resources for case management staff to maintain knowledge, skills and competencies for their roleActing as a resource for staff during the case management process.Collaborate with Manager, Case Management to :Edit, maintain, and implement Policies & Procedures that meet applicable accreditations and business needs.Provide oversight and education to the Case Managers on topics related to case management and review of medical necessity.Review and audit monthly billing for the Case Managers.Complete duties to support Quality Program initiatives including collection of data, reporting and training of employees to meet quality program initiatives.Maintain and report results of satisfaction surveys.Research member complaints and provide resolution.Participate in interview processes and onboarding of new employees.Establish orientation schedule, coordinate, and participate in new employee training as directed.Oversee and evaluate caseloads for applicable employees based on eligibility criteria, needs of member, and employee qualifications.Monitor employee schedules and PTO coverage to meet business needs.Responsible for day-to-day management and performance of a team, provide mentoring and coaching as needed.Lead projects that promote improvement in delivery of services.Complete & report quality assurance reviews, call and chart audits of Case Managers.Performs essential activities of case management while maintaining members' confidentiality, safety, advocacy, adherence to ethical, legal and accreditation and regulatory standards.Consistently exercises discretion and judgment to analyze, interpret, make deductions, and then decide what actions are necessary based on the varying facts and circumstances of each individual case.
Performs assessment by identifying members that meet criteria for CareLink Advanced and financial savings programs within the claims department.Determines measurable goals utilizing motivational interviewing and behavior change model and coaches' clients while monitoring self-care practices.Utilizes industry standard tools to guide individuals with chronic / ongoing health conditions through coaching, assessments, listening, and other techniques as appropriate.Executes activities or interventions to achieve the goals in the plan.Organizes, integrates, and modifies the resources needed to reach the goals in the plan.Monitors all information from all relevant sources in the plan and its activities and services to determine the plan's effectiveness.At repeated intervals, evaluate to determine ultimate effectiveness of plan and modifies plan appropriately to meet the goals.Research medical procedures, treatments, and coding when necessary.Measures the outcomes of interventions.Adheres to practicing the care management core components throughout the continuum of care :Case Management Concepts
Case Management Principles and StrategiesPsychosocial and Support SystemsHealthcare Management and DeliveryHealthcare ReimbursementVocational Concepts and Strategies.Customer ServiceActs as a role model in demonstrating the core values in customer service delivery.
Provides timely and thorough follow up with internal and external customers.Appropriately escalates difficult issues up the chain of command.Quality AssuranceServes on committees, work groups, and / or process improvement teams, as assigned, to assist in improving quality and customer satisfaction.
Recognizes and alerts appropriate supervisor of trends within their scope of responsibility that fall outside of quality parameters.Performs self-quality monitoring to develop and execute plans to meet established goals.Provides ongoing feedback to help optimize quality performance.Collaborates with others and cross-departmentally to improve or streamline procedures.Develops new or improved internal processes to improve quality.Lead, attend, and participate in 1 : 1s, team meetings, trainings, and other job specific events as required.Communicates (in compliance with HIPAA) with brokers, vendors, Relationship Managers, HR representatives and stop loss as needed.Communicates professionally and effectively.Staff complex cases with Manager, Case Management or Senior Manager, Patient Care Services.Adhere to established internal regulations regarding Department of Labor, HIPAA, ERISA and department and company policies and Procedures.Complete HIPAA Training Annually.Perform all tasks in accordance with HIPAA / PHI guidelines.Appropriately escalate difficult issues.Complete duties in accordance with scope of licensure and certifications held or requested.Perform other duties and projects, as assigned.Areas of Responsibility Scope of Practice :
In addition to performing standard duties, the Registered Nurse is involved in clinical decision-making and patient education. The scope of practice includes, but is not limited to :Evaluating clinical dataAssessment and evaluation of the acquired clinical date to assess for appropriateness of treatment based on Imagine360 clinical guidelinesCoordination of treatment plans, interventions, and outcome measurementRationale for the effects of medication and treatmentsProvide patient education and educational resourcesAccurately report :Administration of medication and treatmentsClient responseContact with other health care team members.Respect the client's right to privacy by protecting confidential information.Promote and participate in education and counseling to a participant based on health needs.Clarify any treatment that is believed to be inaccurate, non-efficacious, or contraindicated by consulting with appropriate practitioner.Supervisor, Case Management will have knowledge and practice the core components of Case Management that include :Case Management ConceptsPrinciples of PracticeHealthCare Management & DeliveryHealthcare ReimbursementPsychosocial Aspects of CareRehabilitationProfessional Development & AdvancementQuality and Outcomes Evaluation and MeasurementEthical, Legal and Practice StandardsEducation and Experience :
Required Education :
Nursing degree from an accredited college, university, or school of nursing.Preferred Education :
Bachelor's degree in nursing preferred but not required.Required Experience :
3 years' experience in a clinical role with responsibilities for direct patient care.Experience in Utilization Management, Case Management, or transferable clinical experience and skills.Preferred Experience :
Experience leading and / or mentoring or managing a team of clinical or non-clinical staff.Experience working in a URAC accredited Case Management program preferred.Experience working within an insurance agency or TPA experience specializing in employee benefits and self-funded medical plans.Skills and Abilities :
Ability to work independently in a home office environment.Computer skills which include proficiency in Microsoft Outlook, Word, Excel, and PowerPoint, as well as navigation utilizing the internet.Ability to resolve problems independently and demonstrate ability to multi-task.Strong written, oral, and telephonic communication skills.Strong presentation skills.Ability to demonstrate a commitment to building new skills and fostering a positive work environment.Demonstrated organizational skills, problem-solving, analytical skills, and detail oriented.Demonstrated ability to prioritize workloads, multi-task, and manage priorities to meet deadlines.Ability to maintain the confidentiality of protected health information in compliance with HIPAA regulations.Licenses or Certification :
Current, active, and unrestricted compact Registered Nurse license. Must maintain CEU's as required by the State Board of Nursing. Must be willing to obtain and maintain additional license(s) as required to perform the job functions of the organization.Certified Case Manager (CCM) designation preferred if candidate does not have must pursue and achieve within 2 years of hire.What can Imagine360 offer you?
Multiple Health plan optionsCompany paid employee premiums for disability and life insuranceParental Leave Policy20 days PTO to start / 10 Paid HolidaysTuition reimbursement401k Company contributionCompany paid Short & Long term Disability plus Life InsuranceProfessional development initiatives / continuous learning opportunitiesOpportunities to participate in and support the company's diversity and inclusion initiativesWant to see our latest job opportunities? Follow us on LinkedIn
Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise. Over the years, we've helped thousands of employers save billions on healthcare. Our breakthrough total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions.
Imagine360 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.
RECRUITMENT AGENCIES PLEASE NOTE : Imagine360 will only accept applications from agencies / business partners that have been invited to work on a specific role. Candidate Resumes / CV's submitted without permission or directly to Hiring Managers will be considered unsolicited and no fee will be payable. Thank you for your cooperation