Overview

Our Client, a Fortune 500 company, is a diversified, multi-national healthcare enterprise seeking Case Management, Managers. Must have a BSN and be a Registered Nurse in the state of Alabama. CCM (Certified Case Management) highly preferred.

Purpose:

Perform duties to conduct and manage the day to day operations of the case management functions; communicating with departmental and plan administrative staff to facilitate daily department functions.
• Review analysis of activities, costs, operations and forecast data to determine progress toward stated goals and statistical/financial purposes.
• Promote compliance with federal and state regulations and contractual agreements.
• Develop, implement and maintain compliance with policies and procedures regarding medical case management.
• Develop, implement, and maintain case management programs to facilitate the use of appropriate medical resources and decrease health plan financial exposure.
• Facilitate on-going communication between case management staff, members, contracted providers, and subsidiaries.
• Develop staff skills and competencies through training and experience.

Qualifications:

Education/Experience:
Bachelor’s degree in Nursing.
3+ years case management experience and recent nursing experience in an acute care setting particularly in medical/surgical, pediatrics, obstetrics.
Thorough knowledge of case and/or utilization management and clinical nursing.
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.

License/Certification:

Unrestricted RN license in Alabama.
A valid driver’s license and automobile insurance.
Case Management Certification (CCM) preferred.

Please send resumes to Heather Johnson – Heather@ComplianceSearch.com

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