Manager, Clinical Care Case Management - Remote

RN/BSN required 5 years of management experience 4 years clinical nursing experience At least 4 years of extensive experience in chronic care case management in outpatient setting Certification in case management preferred Must be able to work remotely and obtain state licensure in Illinois, Georgia, Pennsylvania, and Texas Must feel comfortable and confident leading a team of certified but unlicensed personnel and Registered Nurse case managers Ability to read, analyze, and interpret complex documents Ability to respond effectively to sensitive inquiries or complaints

Manage day-to-day Health Plan Clinical Programs to enhance clinical efficiencies Identify opportunities for increased outpatient vs. inpatient utilization Utilize data to manage population health needs and implement programs Execute case management for high-risk patients to decrease adverse events Oversee patient care teams (Social Workers, Liaisons) Oversee Transitional Care Management for discharged patients Ensure Quality Measures are reviewed and addressed Implement and direct Health Plan Health Education Activities Participate in Care Coordination and Quality Committees Monitor corporate initiatives and strategies Manage integration of ACO Programs Maintain collaborative relationships with business partners Manage and execute organizational opportunities and implement changes Manage departmental expectations: staff hiring, orientation, auditing, reviews, time management, motivation, and performance improvement Prioritize data, tasks, and requirements; Project management Represent for health plan audits and develop action plans Oversee projects, productivity, daily tasks, and PHM activities Ensure access to EMR systems for department staff Monitor staff maintenance of HIPPA regulations Communicate with health plan contacts and client managers Identify and disseminate Health Plan announcements