Medical Case Manager - Lead

Description:
Acts as lead clinician providing program supervision of daily operations to an assigned medical/surgical and maternity Case Management team. Maintains regular duties as a Case Reviewer with a reduced caseload. Coordinates with other department leads to ensure continuity in operational processes. This position is also responsible for the Case Management team’s compliance with URAC standards.RESPONSIBILITES: Ensures day to day Case Management department processes are conducted in accordance with URAC standards Serves as Case Manager in accordance with the job description Reviews weekly production reports, monthly accounting and invoices, month-end TSO’s and enrollment/production stats and report findings with team members and Clinical Director. Adjusts work loads and responsible of case managers as needed Provides accurate information to callers as evidenced by system entry/documentation Coordinates staff training with designated department trainer, including the training, testing and certification of UM staff in use of criteria Coordinates QA of data entry efforts on the BEST system for nursing and support staff Coordinates staff to include maintaining and developing daily staff schedule as well as PTO and training requests Approves time via e-time for all staff Develops staff, to include performance evaluations, individual coaching, and conflict resolution as needed Assists in the development and coordination of monthly productivity reports as well as repots to customers Assists with quarterly program reports, bi-annual repots, and special group reports ad others as appropriate. Assist Clinical Director with case management and maternity QA and productivity reports Coordinates and/or participates in interview and hiring process for assigned team Assists Clinical Director or other APS departments with special requests that pertain to the CM department Works with other department team leads in coordinating and participating in administrative meetings with Case Management team and customers
Visit our website at:www.apshealthcare.comReferral bonus available to APS Healthcare Employees*
In accordance to guidelinesAPS HEALTHCARE Bethesda, Inc. and its subsidiaries and affiliates (APS) are Equal Opportunity Employers which employ qualified individuals based upon job related qualifications regardless of race, religion, color, sex, national origin, age, disability, or any other classification proscribed under applicable federal, state, or local law. APS complies with the law regarding reasonable accommodation for disabled employees. Applicants requiring reasonable accommodation in order to participate in the interview process are requested to contact Human Resources in order to arrange such accommodation.
REQUIREMENTS
Requirements:
3 years experience in a behavioral health setting. Medical knowledge and background obtained by completion of a Registered Nurse program.Active unrestricted Registered Nurse (RN) license in Montana. Valid Driver’s license.Must be able to access, research and extract information from printed resources, computer terminals, medical records and telephone interviews on a daily basis. Must have strong organizational skills, the ability to follow directions, interpret instructions, and solve practical problems. Must have excellent communication skills and customer service acumen. Must be able to function independently, effectively, and cooperatively with little supervision, meet assignments, work with a variety of tasks simultaneously, do detailed work and follow tasks through to completion. Previous supervisory experience preferred.Education:
Bachelors degree required in a health care profession or RN with Case Management certification CCM or RN with clinical specialty certification and 5 years of case management experience.