UM O/P Nurse Case Manager

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Imperial Management Administrators Services

Responsible for processes to oversee case management specialty programs, including standardized documentation and auditing, programs that maximize quality, programs to ensure appropriate resource utilization within members benefit plan and established contracts.

Manager is responsible to work in collaboration with other Medical Management Departments to ensure optimal clinical outcomes, appropriate resource utilization, quality patient care, and high enrollee satisfaction.

Job Duties and Responsibilities:

Manages and monitors Enrollees assigned to specialty case management programs to ensure efficient and timely delivery of care, timely referrals, and moving the Enrollee’s treatment plans through the care continuum.
Develops, monitors, and analyzes Program and Department reports and identifies trends to improve clinical and utilization and quality outcomes.
Collaborates with Medical Directors to analyze data and implement programs that will improve Enrollee outcomes.
Develop a standardized process for triaging and enrollment of appropriate members into disease management case management programs.
Identifies and develops Program and Department policies and procedures and ensures compliance and consistency.
Develops and coordinates Program and Department strategies for ensuring the delivery of care in the most cost effective setting.
Act as a resource for hospitalists, SNFs, outpatient utilization management staff, home health care agencies, Employer home-visit physicians and nurse practitioners.
Motivates, instructs, mentors, audits and leads and constantly improves the quality of service and clinical outcomes rendered by the Employer’s the High Risk (Vital Care) Case Management staff.
Develops annual Program and Department goals and objectives focused on improving patient outcomes and efficiency.
Implements tools and processes that direct and role model a high level of customer service behavior toward Enrollees.
Works collaboratively with the entire Medical Management team to ensure that Employer company goals as well as compliance with regulatory and health plan requirements are met.
Oversight responsibility and accountability of case management and ancillary staff.
Experience/Skill Set:

Experience working in a managed care environment preferred
Strong computer and capabilities in MS Word and Excel required
Working knowledge of EZ-CARE/EZ-CAP preferred
Working knowledge of UM and CM industry targets, benchmarks and best practice preferred
Ability to interpret data reports and implement action plans based on the findings preferred
Ability to participate in and support the goals, vision and overall direction of a system designed to care for a population of patients across the care continuum.
Licensure:

Active California LVN or RN license (Texas a plus)
Imperial Management Administrators Services (IMAS) is an Equal Opportunity Employer (EOE) and strongly supports diversity in the workplace. All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, sexual orientation, gender identity, gender expression, national origin, protected veteran status, or on the basis of disability.

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