Manager - (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.

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.Spanish language ability is desirable. Registered Nurse with an active PA licenseBSN with MHA, MPH or related degree preferred5 7 years of managed care or insurance industry experienceAt least 2 years of supervisory/management experienceEffective oral and written communication skills are necessaryExcellent interpersonal communication and problem solving skillsStrong organizational and time management skills

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