Manager RN - DMCCU Health Promotions
Job ID 2013-22119 # Positions 1
Search Category Nursing
Type Regular Full-Time (30+ hours) Posted Date 2/27/2013
Additional Locations ..
More information about this job:Summary:
Responsible for providing clinical supervision to a team responsible for coordinating member service, addressing health and wellness concerns, and ensuring cost effective care management, utilization of health, mental health, and substance abuse services.
1. Manages and oversees teams responsible for various HCMS functions including utilization management, case finding and coordinating those cases that involve co-morbid conditions and need to be part of the case management/disease management track.
2. Responsible for coordination and service delivery to include member assessment of physical and psychological factors.
3. Works with providers to establish short and long term goals that meet the member’s need, functional abilities and referral sources requirements.
4. Communicates care plan objectives utilizing community resources to individuals, departments, and providers identified as having a role in the care of members.
5. Coordinates the identifications of members with potential for high risk complications; assesses members’ present level of physical/mental impairment utilizing defined criteria and methodology.
6. Demonstrates understanding of the physical and psychological characteristics of illness, disabilities and wellness and makes referrals when appropriate.
7. Review benefit systems and cost benefit analysis.
8. Evaluates the member against level of care criteria.
9. Acquires data and evaluates necessary medical, mental health and substance abuse service for cost containment.
10. Perform other duties as assigned.
EDUCATION AND EXPERIENCE
- Nursing Diploma or Associate’s Degree in related Health/Nursing/Social Work field.
Years and Type of Experience Required:
- Bachelor’s Degree in related Health/Nursing/Social Work field or Master’s Degree in related Health/Nursing field.
Certifications or Licensures
- Minimum of five years experience in health Care Management and at least one year of leadership/management experience.
- Certified Case Manager or Certified Utilization Review Professional.
- Proficient in the use of Microsoft Office products, to include Outlook, Word, Excel and PowerPoint.
- Excellent problem solving skills; ability to multi-task and solve complex problems.
- Excellent organizational and analytical skills.
- Strong communication skills, both written and verbal; articulate, persuasive & Influential; systematic and timely.
- Demonstrate project management experience in organizing, planning and executing large-scale projects from conception through implementation.
- Experience in leading and developing people.
# Direct Reports: 2-10
# Indirect Reports: N/A
Budgetary $ Responsibility:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Must be able to operate general office equipment including but not limited to: computer, phones and related media and information devices.
- Ability to communicate both in person and/or by telephone.
- Must be able to travel as needed and adhere to Amerigroup travel policies and procedures.
- 2 years ago - save job
AMERIGROUP looks after the health of America's needy. The managed health care provider targets people eligible for Medicaid, the State...