RN/SW Supervisor-Medicaid – Care – Case and Disease Management

RN/SW Supervisor-Medicaid – Care – Case and Disease Management

Requirements

• High School Diploma/GED required
• Bachelor’s degree preferred or relevant experience in lieu of degree
• Requires 2-4 years of acute healthcare experience
• Prefers one 1 year experience as a supervisor
• Prefers one 1-3 years of experience in the health insurance industry
• Certification as a case manager preferred
• Professional certification in a clinical specialty and at least three years of experience as a case manager preferred
• Active Unrestricted NJ RN/SW License Preferred. Candidates with a restricted license will not be considered.

Responsibilities

• Supervises, analyzes and coordinates the daily activities of the unit to ensure departmental productive goals are met with regards to quality timeliness, accuracy and consistency of medical decisions.
• Continuously evaluates workflow issues and seek to improve processes that impact the managed long term support and services department.
• Coordinates data collection, reviews compliance reports and identifies opportunities for service improvements.
• Recommends, develops and implements department polices and procedures and interfaces with other areas to insure consistent applications.
• Liaison between Medical Directors and staff.
• Develops and monitors goals for staff and provides ongoing feedback and coaching.
• Conducts performance reviews on an annual basis and administers salaries for the staff.
• Directs the employment activities of the office that include staffing, development, and training.
• Ensures staff meets all regulatory requirements and comprehends and complies with best practices, professional standards, internal policies, and procedures.
• Performs the operational duties of a specific clinical care team.
• Ensures an atmosphere within the team, which fosters open communication, teamwork, ownership, and empowerment to make decision.
• Develops key performance indicators to evaluate level of service for internal and external customers.
• Acts as technical expert and reference point for difficult and complex matters.
• Facilitates the creation of service and processing innovations within the team. Shares innovations with other teams and market divisions.
• Assists in preparing and monitoring the budget to ensure administrative cost objectives are met. Identifies and implements cost saving/revenue generating opportunities.
• Interprets and executes policies for the team.
• Participates in special projects initiated by the Plan.
• Assists manager in coordinating regulatory, quality and accreditation activities.
• Represents the plan with external customers, providers and agencies.
• Represents the department on internal committees.

Preferred Qualifications

• 2-4 years of acute healthcare experience
• 1 year experience as a supervisor preferred
• 1-3 years of experience in the health insurance industry preferred
• Certification as a case manager preferred
• Professional certification in a clinical specialty and at least three years of experience as a case manager preferred