Highmark Health - Manager Complex Case Management - RN (Remote)
Location: Cheyenne, Wyoming
This job will lead a team of Registered Nurse Complex Case Managers that deliver case management services to a specified panel of the Organization's members that range in health status/severity and clinical needs. Accountable for daily operation of unit including staffing and scheduling to ensure that member outreach is effective and completed within defined time-frames and according to established processes. This job ensures that team members are clinically competent and adequately trained in order to achieve member engagement targets as well as defined clinical and financial outcomes. Establishes and monitors individual and team performance goals providing feedback and taking action to ensure that goals are achieved.
ESSENTIAL RESPONSIBILITIES
- Perform management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.
- Plan, organize, staff, direct and control the day-to-day operations of the department; develops and implements policies and programs as necessary; may have budgetary responsibility and authority.
- Assist with focusing activities toward a strategic direction as well as develop tactical plans, drive performance, and achieve targets, in collaboration with the Director.
- Ensure that team members are clinically competent and adequately trained in motivational interviewing and other engagement techniques in order to achieve the market’s engagement and clinical targets for assigned population. Ensures on-going staff development through education and opportunities for professional development.
- Review department performance in relation to established metrics and implements changes in collaboration with other multidisciplinary team managers to effect continual improvement in the services provided.
- Lead/participate in both departmental and interdepartmental work groups to continually enhance the delivery of programs and services and proactively respond to changing client and market expectations.
- Participate in preparation of department budget. Makes budgetary recommendations and projections. Monitor, verify, and reconcile expenditures of budgeted funds. Identify cost savings opportunities within the department and/or operations, in collaboration with the Director.
- Ensure that all services are delivered consistent with applicable internal policies and procedures as well as applicable CMS, state, local, and regulatory agency requirements and applicable standards of practice for case management.
- Other duties as assigned or requested.
REQUIRED EDUCATION
- Bachelor's Degree in Nursing
Substitutions
- 6 years of experience in the Healthcare field
Preferred
- Master's Degree in Nursing
EXPERIENCE
Required
- 7 years of any combination of clinical and case management
- 3 years of management/supervisory or leading/working on project teams
Preferred:
- Working with the healthcare needs of diverse populations
- Understanding of the importance of cultural competency in addressing targeted populations
SKILLS
- Written and verbal presentation skills, negotiation skills, and skills in positively influencing others with respect and compassion
- Excellent interpersonal and communication skills and the ability to work in a matrix management environment
- Understanding of healthcare costs and the broader healthcare service delivery system
- Strong analytic skills with ability to interpret, evaluate and act on productivity, clinical and financial data
- Proficient computer skills, including Microsoft Office products. Proficiency in MS Excel and enhanced data and statistical analysis skills
- Excellent interpersonal/consensus building skills as well as the ability to work with a variety of internal and external colleagues from all levels of an organization
- Ability to work in a high performing team environment that requires flexibility
- Excellent organizational, time management and project management skills Demonstrated ability to handle multiple priorities in a fast paced environment
Required Licensure
Preferred
- Certification in Case Management
LANGUAGE REQUIREMENT (other than English)
None
TRAVEL REQUIREMENT:
0% - 25%
PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS
Position Type
Teaches/Trains others regularly: Rarely
Travels regularly from the office to various work sites or from site-to-site: Rarely
Works primarily out-of-the office selling products/services (Sales employees): Does Not Apply
Physical Work Site Required: No
Lifting: up to 10 pounds: Rarely
Lifting: 10 to 25 pounds: Rarely
Lifting: 25 to 50 pounds: Rarely
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
Pay Range Minimum: $78,900.00
Pay Range Maximum: $146,000.00
Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law.
EEO is The Law
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )
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