Director, Case Management
On-siteWheeling, West Virginia, United States
Job Summary
Oversee medical and Care Continuum operations, providing direct supervision to managers and supervisors. Develop and monitor training programs, while continuously reviewing and revising care continuum processes, policies, and procedures. Ensure all programs comply with CMS, BMS, NCQA, and other regulatory requirements, and drive adherence to quality outcomes like STAR measures and HEDIS. Collaborate with the CMO, VP of Clinical Services, and Director of Utilization Management to align initiatives with organizational goals and integrate programs with provider health systems. Implement and monitor third-party software, develop management reporting metrics, and lead clinical services compliance and NCQA initiatives. Interact with government agencies, health systems, and employer groups to facilitate program integration. Requires an active Ohio or West Virginia RN license with five years of managed care experience and two years in a management capacity.
Required Qualifications
- Registered Nurse
- minimum of 5 years clinical experience
- At least two years of experience in a management capacity
- Bachelor's of Science degree in Nursing
- willingness to obtain Bachelor's of Science degree in Nursing within 2 year of hire
- active and unencumbered Ohio or West Virginia multi-state registered nurse license
- Minimum of five years in a managed care organization
Desired Qualifications
- public speaking skills
- excellent written communication skills
- motivation
- initiative
- ability to work independently
- superior work ethic
- Experience in writing policies and procedures
- Proven leadership abilities
- strong verbal skills
- written analytical skills
- interpersonal skills
- flexibility
- ability to multi-task
- ability to work in a fast paced environment
- ability to adapt to changing processes
- Self-starter
- strong entrepreneurial skills
- Certification in related area
- Certified Case Manager (CCM)
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