Assistant Manager overseeing day-to-day operations in case management nursing team. Ensure team performance and compliance with Highmark policies.
Responsibilities
Oversees the implementation of Highmark Clinical Case Management Support including but not limited to Case Management (CM) screening/Telephonic Outreach/Program Enrollment/Task Support for Case Management and monitors daily performance to ensure business goals are met and compliance with Highmark policies and procedures is maintained.
Implements clinical policies & procedures in accordance with NCQA, URAC, state and federal standards and mandates.
Serve as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking.
Ensure implementation and monitoring of best practice approaches and innovations to better address the member's needs across the continuum of care.
Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
Manages resources responsible for identification of members, development and implementation of care plans, enhancement of medical appropriateness and quality of care and monitoring.
Communicates productivity expectations, balance workload (e.g., daily team meetings to discuss new referrals), monitor efficiency and initiate control measures to minimize variances in workload over time.
Ensures the team's understanding and use of information system capability and functionality.
Requirements
Active PHRN with minimum 1 year bedside experience.
Communication Skills Requirement (B2-C1 in HLEAP)
Benefits
Active PHRN with minimum 1 year bedside experience.
Communication Skills Requirement (B2-C1 in HLEAP)
Job title
Assistant Manager – Healthcare Operations Management, Case Management Nursing
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