Job Title: RN Manager, Care Management | Health Plan | Sioux Falls
City: Sioux Falls
Department: Care Management - Sioux Falls
Job Schedule: Full Time
Hours Per Shift: 8 hr
Responsible for the daily operations of the Care Management department. Responsible for the development and implementation of case management and quality programs.
Works with other Health Plan Departments to ensure that the needs of clients are met in a timely and effective manner. Possesses strong leadership skills. The Manager of the Care Management department is responsible for day-to-day department operations including services provided to members, supervision of department staff and oversight of the quality program. Assists the medical team to coordinate, develop, and implement programs and workflows related to care coordination and quality programs. Reviews case management cases regularly with staff, acts as clinical consultant regarding care management issues, guides clinical staff with review of assessments, care plans, and documentation. The Manager provides oversight of the quality programs, quality interventions and department regulatory requirements. Attends Health Plan administrative meetings as needed and actively participates in the operations of the Health Plan. Maintains necessary departmental records and reports as required by policy, state and federal requirements, reinsurance, and National Committee for Quality Assurance (NCQA). Assists in education and training of new staff. Active role in annual budget development. Acts as a liaison between other departments within the Health Plan. Provides clear and concise instructions to staff in a collaborative manner. Works with all stakeholders to ensure client communication is timely and accurate including Care Management generated reports. Displays professional ownership and follow-up of assigned duties through communication with colleagues, managers, and staff. Prioritizes duties based on need and as directed by the Care Management Director and VP, Medical Officer. Ability to generate, review, analyze, and summarize reports. Effective oral and written communication skills. Works in an office environment and is primarily telephonic/computer based. Ability to travel monthly between offices.
Consults on latest accreditation and performance standards.;Contributes to best practices for effective problem resolution process.;Aligns personal day-to-day activities with business goals;Documents program management requirement and selects appropriate tools and resources.;Streamlines the critical workflow for executing key processes.;Ensures staff development is in line with strategic organizational and departmental objectives.;Analyzes complex financial statements and reports for health insurance.;Oversees staff in the implementation of training evaluation for individuals, teams and departments.;Mediates and resolves conflicts among individual, groups, and departments.;
Bachelor's degree in Nursing is required. Graduate form a nationally accredited nursing program preferred, including, but not limited to, Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA).
Previous experience in case management is required. Management, leadership, Healthcare Effectiveness Data and Information Set (HEDIS), and accreditation experience is preferred. Minimum of 5 years nursing experience is required.
Currently licensed with applicable state nursing board and/or possess multistate licensure privileges as required by position. Current Commission for Case Manager Certification (CCMC) is preferred or is to be obtained within 18 months of employment. Certified Professional in Healthcare Quality (CPHQ) certification is preferred.
About Sanford Health:
At Sanford Health, we are dedicated to the work of health and healing.
Every day, we show that commitment by delivering the highest quality of care to the communities we serve.
We are leaders in health care and strive to provide patients across the region with convenient access to expert medical care, leading-edge technologies and world-class facilities.
In addition to strong clinical care, we are also committed to research, education and community growth.
We engage in medical research to not only discover innovative ways to provide care, but also cures for common diseases.
We continuously seek new ways to achieve our vision of improving the human condition here in your community, across the region and around the world.
The entire team at Sanford Health recognizes the value of healthy families and communities.
We continue to gain momentum and expand our reach. Together, we can make a positive difference now, and in the future.
Sanford is an EEO/AA Employer M/F/Disability/Vet.
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City: Sioux Falls
Job Function: Nursing
Job Schedule: Full Time
Req Number: WD08685