Health Care Management Systems Manager - Remote
Description:
• Manages and oversees the team responsible for case finding and coordinating cases that involve comorbid conditions.
• Coordinate service delivery to include member assessment of physical and psychological factors.
• Partners with providers to establish short- and long-term goals that meet the member’s needs, functional abilities, and referral sources' benefit systems and cost-benefit analysis.
• Evaluates medical, mental health, and substance abuse services for cost containment.
• Supports program compliance and assists in identifying opportunities to improve customer service and quality outcomes.
• Supports quality initiatives and activities, including adherence to National Committee for Quality Assurance (NCQA) standards and HEDIS reporting.
Requirements:
• Requires BA/BS and a minimum of 5 years of experience in Health Care Management
• Or any combination of education and experience, which would provide an equivalent background.
• Current active unrestricted RN, PA, LSW, LCSW, LPC, LMHC, or other accepted license (as allowed by applicable state laws) and any other state or federal requirements that may apply are required.
• Managed care experience preferred.
• Project management experience preferred.
• Experience interpreting contracts, creating policies and procedures, and managing regulatory requirements is preferred.
Benefits:
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• Manages and oversees the team responsible for case finding and coordinating cases that involve comorbid conditions.
• Coordinate service delivery to include member assessment of physical and psychological factors.
• Partners with providers to establish short- and long-term goals that meet the member’s needs, functional abilities, and referral sources' benefit systems and cost-benefit analysis.
• Evaluates medical, mental health, and substance abuse services for cost containment.
• Supports program compliance and assists in identifying opportunities to improve customer service and quality outcomes.
• Supports quality initiatives and activities, including adherence to National Committee for Quality Assurance (NCQA) standards and HEDIS reporting.
Requirements:
• Requires BA/BS and a minimum of 5 years of experience in Health Care Management
• Or any combination of education and experience, which would provide an equivalent background.
• Current active unrestricted RN, PA, LSW, LCSW, LPC, LMHC, or other accepted license (as allowed by applicable state laws) and any other state or federal requirements that may apply are required.
• Managed care experience preferred.
• Project management experience preferred.
• Experience interpreting contracts, creating policies and procedures, and managing regulatory requirements is preferred.
Benefits:
Apply Now
Apply Now