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Supervisor, Medical Management (Clinical - RN Required)

Buffalo, NY · Healthcare
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.


Position Overview: 
Supervise the day-to-day operations of the medical management, utilization and case management functions for the corporate nursing clinical team and centralized transplant unit.


Responsibilities: 
  • Oversee daily operations of specific areas within the Medical Management department
  • Assist senior management with input surrounding budgets and forecast for strategic planning and key initiatives. Balance current and future needs effectively.
  • Ensure compliance with established work processes related to concurrent review, case management, referrals, pre-authorization policies, procedures, and processes
  • Assure that Medical Management Operational Services functions and responsibilities are coordinated with other operating departments of health plans and Corporate teams
  • Assist senior management with statistical analysis of utilization data
 
Required Qualifications: 
  • Associate’s degree in Nursing or equivalent experience. Bachelor’s degree preferred.
  • 3+ years nursing experience, case/utilization management or quality improvement in a healthcare environment, preferably managed care.

Licenses/Certifications: Current state’s RN license.

Benefits: 
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. 
  • Health insurance
  • Dental insurance
  • Vision insurance
  • Flexible spending accounts (includes health care, dependent care mass transit reimbursement)
  • Short- and long-term disability insurance
  • Basic Life insurance
  • Supplemental AD&D
  • Supplemental life insurance
  • Wellness Program
  • 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
  • Service Awards
  • 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
 
Kat Forester
ProEnlist, LLC

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