Job Description

Job descriptionPosition 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 managementReview 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 managementEnsure compliance with federal and state regulations and contractual agreementsDevelop, implement, and maintain case management programs to facilitate the use of appropriate medical resources and decrease health plan financial exposureQualifications: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 conditionsLicense/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.
Associated topics: business development, case manager, development, liaison, plan, project, program development, program management, project management, resource development

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