Manager, Federal Employee Program (FEP)Case Manager Job in Jacksonville, Florida US
Job duties include but are not limited to the
following:
Description
THIS POSITION CAN BE LOCATED IN JACKSONVILLE, TAMPA, SARASOTA, PENSACOLA, MIAMI, FT. LAUDERDALE OR LAKE MARY
Job duties include but are not limited to the following:
*Responsible for managing the day-to-day operations of an integrated Case/Care Management programs within the Clinical Program unit
*Assist in development, improvement and the oversight to the case management process and activities of which the staff conduct telephonic outreach to members and to coordinate, monitor plans of treatment for Case Management services
*Ensure Case Management team is identifying quality driven cost effective and alternatives, present proposals to providers and members, perform ongoing assessments and apply appropriate interventions and document information according to documentation standards
*Develop strategies and supportive initiatives to increase our overall member engagement rates in Clinical Care Programs
*Responsible for ensuring appropriate coaching, training mentoring, interviewing and hiring for staff
*Propose changes related to Continuous Quality/Process Improvement (QI) initiatives and management activities
*Ensure adherence to all Corporate Compliance Standards, Standard Operating Procedures (SOPs) and regulatory requirements (National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), and Center for Medicare/Medicaid Services (CCMS) and Utilization Management (UM)
*Develop effective coordination with Federal Program Director’s Office (FEPDO) personnel and multiple corporate areas to facilitate compliance and accreditation requirements
*Collaborate with Medical Directors, Manager, co-workers and other departments
*Provide technical leadership and consulting for the elements of research, design and issue resolution in addressing Federal Employee Program (FEP) operational preparations for Utilization Review Accreditation Commission (URAC) and Federal Employee Program Director’s Office (FEPDO) compliance visits
Job Requirements:
*Active Florida RN license
*5 or more years directly related work experience in one or more of the following areas of Case/Care Management (i.e., complex, specialty or general)
*2 or more years of direct supervisory/leadership experience with direct reports and providing ongoing evaluation and individual performance reviews
*Current certification in Case/Care Management (CM)
*Experience with Compliance Standards and regulatory guidelines such as National Committee for Quality Assurance (NCQA), Center for Medicare/Medicaid Services (CMMS), and Utilization Review Accreditation Commission (URAC)
*Experience in Continuous Quality/Process Improvement initiatives
*Experience working with both the Healthcare and Managed Care (health insurance) industry
*Occasional (10-20%) travel within the State of Florida
Business Specific Criteria (preferred skills):
*Bachelor’s degree in Nursing
*Experience working with MS Word, MS Excel, MS PowerPoint and MS Outlook
*Understanding of decision making criteria (InterQual, Medical Coverage Guidelines)
*Experience with managing staff located statewide and those participating in alternative work arrangements
If interested, please apply online at http://track.tmpservice.com/ApplyClick.aspx?id=1416718-1789-9272