About the Company:
A Fortune 500 company, is a diversified, multi-national healthcare enterprise that provides a portfolio of services to government sponsored healthcare programs, focusing on underinsured and uninsured individuals. Many receive benefits provided under Medicaid, including the State Children's Health Insurance Program (CHIP), as well as Aged, Blind or Disabled (ABD), Foster Care and Long Term Care (LTC), in addition to other state-sponsored/hybrid programs, and Medicare (Special Needs Plans).
The Company operates local health plans and offers a range of health insurance solutions. It also contracts with other healthcare and commercial organizations to provide specialty services including behavioral health management, care management software, correctional healthcare services, dental benefits management, in-home health services, life and health management, managed vision, pharmacy benefits management, specialty pharmacy and telehealth services.
Conduct and manage the daily operations of the case management function
- Ensure successful transition of care for members from case management to the utilization management
- Review analyzes of activities, costs, operations and forecast data to determine progress toward stated goals and statistical/financial purposes.
- Develop, implement and maintain compliance with policies and procedures regarding medical case management
- Ensure compliance with federal and state regulations and contractual agreements
- Develop, implement, and maintain case management programs to facilitate the use of appropriate medical resources and decrease health plan financial exposure
- Bachelor’s degree in nursing or equivalent experience.
- 4+ years of combined clinical nursing and case management experience.
- 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: RN license, Licensed Clinical Social Worker (LCSW), or Licensed Clinical Professional Counselor (LCPC), valid driver’s license and automobile insurance. Case Management Certification (CCM) preferred.
The company offers more than just medical insurance. They pay most of your benefits costs and in some cases – they pay 100 percent. Most of the benefits not covered by the company are paid with pre-tax payroll deductions.
Flexible spending accounts (includes health care, dependent care mass transit reimbursement)
Short- and long-term disability insurance
Basic Life insurance
Supplemental life insurance
401(k) retirement with company match
Employee stock purchase plan
Vacation, Personal and Sick time
Paid Company Holidays
Employee Assistance Program (EAP)
Training and Learning Opportunities
Tuition Reimbursement/Educational Assistance
On-site fitness center or discount at local fitness centers (most locations)
Discounts for select local and national products and services, including cell phones, computers and more
Other amenities may be available, but vary by location