Manager, Large Case Management
New
L
Lucent HealthHealthcare Management
United StatesFull-TimeManager
Salary not disclosed
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Job Details
- Experience
- 3-5 years of clinical nursing experience; minimum 3 years in a healthcare leadership role
- Required Skills
- Microsoft OfficeQuality AssuranceHIPAA
Requirements
- Registered Nurse (RN) with a current, active, and unrestricted license in a US state or territory.
- Bachelor’s degree from an accredited college or university.
- Minimum of 3-5 years of clinical nursing experience.
- Minimum of 3 years of experience in a healthcare leadership role (e.g., team lead or higher).
- Proven ability to manage and lead a team of direct reports.
- Strong analytical skills with high attention to detail.
- Proficiency with Microsoft Office products.
- Excellent written and verbal communication skills.
- Ability to identify process gaps and develop actionable improvement plans.
- Certified Case Manager (CCM) certification preferred.
Responsibilities
- Provide strategic and operational leadership for the Large Case Management program, ensuring alignment with organizational goals and clinical best practices.
- Oversee daily operations through direct leadership of Supervisors, ensuring productivity, quality, timeliness, and documentation standards are met.
- Establish and monitor key performance indicators (KPIs), identifying trends and implementing action plans to improve outcomes and efficiency.
- Lead the development and execution of case management strategies for high-cost and complex cases to optimize clinical outcomes and financial impact.
- Support Case Management vendor strategy, performance monitoring, and evaluation of referral appropriateness and outcomes.
- Ensure compliance with all accreditation, regulatory, and contractual requirements (e.g., state, federal, URAC, NCQA, HIPAA).
- Partner with Finance and leadership to ensure accuracy, integrity, and insights within stop loss reporting and high-cost claim analysis.
- Lead internal and external audits, quality assurance initiatives, and regulatory readiness efforts.
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