This position is responsible for developing, implementing, coordinating, and maintaining Case Management strategies and programs to enhance general health care outcomes for members of all product lines; establishing cost-containment goals and objectives for the department along with policies, practices, and procedures needed to meet those objectives; and representing the company and division before outside customers and consultants.
1) Registered Nurse with unrestricted license in the State of Texas.
2) 3 years clinical experience; physicians office, hospital or surgical experience.
3) 2 years case management program oversight experience.
4) 2 years supervisory or management experience.
5) Experience utilizing Total Quality Management (TQM)/Continuous Quality Improvement (CQI) concepts.
6) Knowledge of medical terminology and procedures.
7) Knowledge of managed care products and programs.
8) Knowledge or experience using National Committee for Quality Assurance (NCQA) or other accrediting agency standards.
9) Multiple project leadership and program development skills.
10) Verbal and written communications skills; interpersonal and organizational skills.
11) PC proficiency to include Microsoft Windows.
12) Ability to travel, including overnight stays.
PREFERRED JOB REQUIREMENTS:
1) Case Management Certification (CCM).