Manager, Case Management Operations

Team Supervision & Support 

• Provide ongoing training, mentoring, coaching, and disciplinary action as directed.
• Monitor daily activities of the team and serve as a resource for questions, issues, or concerns.
• Conduct regular 1:1 and team meetings (remote) with staff and manager.
• Offer direct, confidential feedback to staff regarding quality audits and performance improvement.
• Conduct corrective action and counseling, document interventions, and communicate outcomes to manager.
• Assist with interview and hiring processes as needed. 

Staffing & Operations

• Evaluate caseloads for appropriate staffing based on criteria, member needs, and staff qualifications. 
• Collaborate with manager to supervise and coordinate staff activities, ensuring adequate coverage and workload distribution. 
• Assist with coordination and facilitation of team, department, and case rounds meetings. 

Performance Management

• Document staff performance and assist manager with performance evaluations. 
• Provide suggestions for individual performance improvement. 
• Participate in projects, committees, and other activities as directed. 

Quality & Risk Management 

• Identify and escalate potential or actual risk management issues. 
• Research complaints and assist in resolution as directed. 
• Identify opportunities for process improvement in case management services. 

Professional Development & Compliance 

• Maintain knowledge of beneficiary benefits, contracts, policies, professional standards, and community resources. 
• Stay informed about the scope of professional licensure and ensure team compliance. 
• Maintain required CEUs and obtain/maintain additional licenses as needed. 
• Pursue case management certification if not already certified. 

Required

• 3+ years of clinical RN experience in a clinical role with responsibilities for direct patient care 
• 3+ years’ experience managing a team of clinical staff 
• Bachelor’s degree in nursing from an accredited college, university, or school of nursing  
• Current, unrestricted Registered Nurse license in the state of residence or compact state and ability to obtain multi-state licensure 
• Ability to obtain Security Clearance required. Current DOD Security Clearance preferred  
• Must hold United States citizenship status  
• Proficient in Microsoft Office product suite (Word, Excel, PowerPoint, Outlook, Teams) and mobile technologies (laptop, smartphone apps, etc.)  

Preferred

• Experience working in a NCQA and URAC accredited program
• Active, unrestricted Certified Case Manager (CCM), or ability to obtain a case management certification (CCM)
• Experience as a telephonic case manager at a health plan highly desirable  
• Experience as a utilization management mentor highly desirable 
• Experience mentoring or supervising a team of clinical or non-clinical staff in multiple time zones 
• Commitment to building team skills and fostering a positive work environment   
• Knowledge and application of best-practice case management and patient-centered care concepts  
• Knowledge of current professional standards of case management   
• Knowledge of payor issues, including benefits and contract limitations, provider network issues, and case management initiatives  
• Ability to work effectively in a cross-functional team environment and adapt to changing program or organizational priorities  
• Ability to work independently in a home office environment