Supervisor, Care Management
Location: Baton Rouge, Louisiana
Description: is at present looking to employ Supervisor, Care Management right now, this vacancy will be assigned in Louisiana. Further informations about this vacancy opportunity kindly see the descriptions. Position Purpose:
Supervise the day-to-day operations of the case management function. Communicate with departmental and plan administrative staff to facilitate daily department functions.
Knowledge/Experience:
Nursing education. Thorough knowledge of a specialized or technical field such as clinical nursing, case and/or utilization management. At least 3 years of recent nursing experience in an acute care setting particularly in medical/surgical, pediatrics, or obstetrics. At least 1 year of case and/or utilization management experience. Data management experience preferred.
Position Responsibilities:
- Assure compliance with established referral, pre-certification and authorization policies, procedures and processes by related Medical Services staff.
- Assure compliance with established onsite and concurrent review, case management, referral, pre-certification and authorization policies, procedures and processes.
- Assure compliance with emergency management policies, procedures and processes.
- Facilitate on-going communication between case management staff, utilization management staff and contracted providers.
- Assist with the implementation of policies and procedures regarding medical case management.
- Maintain compliance with federal and state regulations and contractual agreements.
- Coordinate and communicate medical service functions with other departmental functions.
- Act as medical resource for appeals function.
- Assist Medical Services staff with computer systems issues related to case management.
- Conduct telephonic review of cases with doctors, hospitals, and other providers.
- Compile and review multiple reports for statistical and financial tracking purposes to identify case management trends and assist in financial forecasting.
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This vacancy starts available on: Mon, 06 Aug 2012 08:23:35 GMT
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