Manager Case Management - (US-PA-Philadelphia - 19255)

Minimum Education: None
Job Type: Full Time
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Responsibilities : Direct and coordinate activities related to the case management function to further the goals and objectives of the department, health plan and Company. Assign work through matrix structures as necessary. Review analyses of activities, costs, operations and forecast data to determine progress toward stated goals and objectives.Significant Duties: Assure compliance with established onsite and concurrent review, case management, referral, pre-certification and authorization policies, procedures and processes. Perform case management and disease management functions as necessary. Assist staff with the resolution of issues related to the case management function.Methods and Procedures: Develop, implement and maintain policies and procedures regarding the case management function.Performance Standards and Measures: Develop, implement, and maintain case management programs to facilitate the use of appropriate medical resources, decrease health plan financial exposure, and create performance standards.Reports: Compile and review multiple reports on work function activities for statistical and financial tracking purposes to identify utilization trends, assist in financial forecasting, and make recommendations to management. Monitor and report on achievement of committed action plans to appropriate health plan and corporate management.Communication/Liaison: Facilitate on-going communication between case management staff, health plan staff and contractors. Serve as contact for corporate and health plans, providers and external customers regarding case management matters; multi-directional communications required.People Management: Create effective organizational structure, roles and jobs. Develop staff skills and competencies through training and experience. Select or hire individuals wisely into new roles. Coach and mentor. Lead by example to create desired culture and motivated people in organization. Assure appropriate management and skills development for self and staff.

Requirements :MS Office SuiteAbility to analyze data and employ approved management techniques and statistical tools to obtain maximum effectiveness, efficiency, and information.Ability to utilize continuous quality improvement philosophies, techniques, and tools in all aspects of the position.Ability to align all work and resource management with Bravo Health mission, vision, philosophies, and values, as well as with its goals and strategic imperatives.

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