RN Case Management Manager

General Summary: The Case Management Manager will be responsible for oversight of the High-Risk team and the Case management team by managing performance metrics, conducting audits, and maintaining staff trainings. Ensures timely care plans are developed and implemented to optimize patient outcomes and utilization management.

Supervisory Responsibilities: Supervises assigned staff. Carries out supervisory responsibilities in accordance with the organization’s policies and applicable laws. Responsibilities include interviewing and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

General Requirements: All duties performed will be done accurately and in a timely manner.

1. Able to work efficiently under pressure.
2. Assumes responsibility for maintaining clinical competencies according to Gonzaba Medical Group policy.
3. Must always adhere to customer service expectations including in-person and virtual (via telephone, or telehealth applications) communication.
4. Ensures customer service is always maintained at the highest level.
5. Exercise tact and courtesy when dealing with patients, visitors, providers, and co-workers.
6. Participates in educational programs as needed.
7. Other duties as assigned.

Essential Job Responsibilities:

1. Directs day-to-day departmental activities including scheduling, staffing and oversight of daily operations. Coordinates work schedules, coverage plans and assignments for Case Management/High Risk Team (CM/HR).
2. Participates in defining annual departmental goals/objectives and takes responsibility for their achievement. Effectively engages CM/HR staff in accomplishment of goals.
3. Assists with hiring, training, on-going supervision, discipline, and evaluation of staff. Helps provide a comprehensive orientation and staff development program. Provides timely feedback and staff evaluations.
4. Ensures that CM/HR team supports effective Patient Care Committee, High Risk and Small Group Meetings.
5. Ensures that CM/HR staff maintains strictest member and company confidentiality; ensures member health information is secured each day; Demonstrates HIPAA knowledge and focus
6. Identifies opportunities for operational improvement and works collaboratively with the CM/HR team and other GMG staff. Communicates effectively with clinic staff, internal providers, patients, and external providers regarding CM/HR matters.
7. Monitors the status of work, via reports, flags, phone calls, and other means. Facilitates the process to ensure timely service to patients and providers.
8. Reviews and monitors the work performed and documentation in Electronic Medical Record (EMR) to evaluate knowledge, skills, quality of care and appropriateness of documentation.
9. Ensures that Census, Radar Report, Bed Days report and High-Risk Patient Status are completed accurately and distributed in a timely manner.

Education and Training: Graduation from an approved LVN or RN program. Must be state-licensed LVN or RN with a minimum of three years of LVN or RN experience, clinic experience preferred. Must have prior medical terminology. Must have excellent customer service skills. supervisory experience. Prior managed care experience preferred.

Experience: Must have a minimum of 2 years of leadership experience in Managed Care. RN and IV certifications are required.

Other Requirements: Computer Skills: Skilled in use of computer/EMR systems. Knowledge of Word processing software, spreadsheet software, Internet, and database software.

Work Environment: This role is primarily in an office environment, though there may be periods of time spent in clinic or construction environments depending on projects assigned. Exposure to communicable diseases, bodily fluids, toxic substances, ionizing radiation, medicinal preparations, and other conditions are common to a clinic environment. Exposure to debris, dust, sharp objects, chemicals and electricity are common to construction environments. Gonzaba Medical Group will provide training and appropriate PPE as required to be successful and safe in your work environments.

Mental / Physical Requirements: Requires manual dexterity, sitting, standing, stooping, reaching, kneeling, crouching, bending, walking, lifting up to 40 lbs. without assistance. Close vision and ability to adjust focus. Must be able to work efficiently under pressure.

Additional Information: Gonzaba Medical Group is seeking team members who contribute as A-Players, demonstrate a strong work ethic, are committed to our culture and core values.

Other Duties As Assigned: The above job description is not intended to be an all-inclusive list of duties and standards of the position. Team members will follow any other instructions, and perform any other related duties, as assigned by their supervisor. Responsibilities, knowledge, skills, abilities, and work environments may change as needs evolve.