Supervisor, Case Management

Location: Pennsylvania-Harrisburg
Duration: Full Time
Job ID: 1168297 (22001075)
Company: ProEnlist
Contact: April Estes    Call: 7204392609
Job Posted: 04/28/21

Supervisor, Case Management - 1168297 (22001075)

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 case management function. Communicate with departmental and plan administrative staff to facilitate daily department functions.


Responsibilities: 

  • Assure compliance with established referral, pre-certification and authorization policies, procedures and processes by related Medical Services staff.
  • Assure compliance with established onsite and concurrent review, case management, referral, pre-certification and authorization policies, procedures and processes.
  • Assure compliance with emergency management policies, procedures and processes.
  • Facilitate on-going communication between case management staff, utilization management staff and contracted providers.
  • Assist with the implementation of policies and procedures regarding medical case management.
  • Maintain compliance with federal and state regulations and contractual agreements.
  • Coordinate and communicate medical service functions with other departmental functions.
  • Act as medical resource for appeals function.
  • Assist Medical Services staff with computer systems issues related to case management.
  • Conduct telephonic review of cases with doctors, hospitals, and other providers.
  • Compile and review multiple reports for statistical and financial tracking purposes to identify case management trends and assist in financial forecasting.



Qualifications:
Education/Experience:

  • 3+ years of nursing experience in an acute care setting particularly in a medical/surgical, pediatrics, or obstetrics environment.
  • 1+ year of case and/or utilization management experience.
  • Working knowledge of a specialized or technical field such as clinical nursing, case and/or utilization management.
  • Previous experience as a lead in a functional area or managing cross functional teams on large scale projects.
  • Data management experience preferred.


License/Certification:

  • Valid driver's license.
  • 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


Qualifications:
Education/Experience:

  • 3+ years of nursing experience in an acute care setting particularly in a medical/surgical, pediatrics, or obstetrics environment.
  • 1+ year of case and/or utilization management experience.
  • Working knowledge of a specialized or technical field such as clinical nursing, case and/or utilization management.
  • Previous experience as a lead in a functional area or managing cross functional teams on large scale projects.
  • Data management experience preferred.


License/Certification:

  • Valid driver's license.
  • Current state's RN license.