Supervisor, Case Management - Remote/Field
Company: Sunshine State Health Plan
Location: Hialeah
Posted on: May 27, 2023
|
|
Job Description:
You could be the one who changes everything for our 26 million
members as a clinical professional on our Medical Management/Health
Services team. Centene is a diversified, national organization
offering competitive benefits including a fresh perspective on
workplace flexibility. Position Purpose: Supervise the day to day
operations of the case management function. Communicate with
departmental and plan administrative staff to facilitate daily
department functions.
This is a remote position, with some travel required within the
state of Florida. Candidates must reside within FL and must be
willing to travel to be considered for this role.
Must have a minimum of 3 years of management/supervisory experience
in the health care field and at least 2 years of pediatric
experience.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.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.For Florida plan only: RN, LCSW, LCMHC or other
Clinical Mental Health Professional license required.Employees
supporting Florida's Children's Medical Services (CMS) must have a
minimum of 3 years of management/supervisory experience in the
health care field and at least 2 years of pediatric experience.Our
Comprehensive Benefits Package: Flexible work solutions including
remote options, hybrid work schedules and dress flexibility,
Competitive pay, Paid time off including holidays, Health insurance
coverage for you and your dependents, 401(k) and stock purchase
plans, Tuition reimbursement and best-in-class training and
development.Centene is an equal opportunity employer that is
committed to diversity, and values the ways in which we are
different. All qualified applicants will receive consideration for
employment without regard to race, color, religion, sex, sexual
orientation, gender identity, national origin, disability, veteran
status, or other characteristic protected by applicable law.
Keywords: Sunshine State Health Plan, Hialeah , Supervisor, Case Management - Remote/Field, Executive , Hialeah, Florida
Click
here to apply!
|