Responsible for implementing and managing the case management/care coordination activities to control costs of high-risk, high-cost cases. Identifies cost-effective protocols for high-risk, high-cost diagnoses and develops cost-effective care plans. Develops guidelines for working with insurers, managed care organizations, patients, and families.
Bachelor's degree required, Master's preferred, Case Management certification preferred.
Demonstrated hands-on leadership and operational responsibility in a large/complex healthcare environment with 5-7 years' experience of successful management experience and in-depth understanding of managed care, experience in budgeting and strategic planning of goals and objectives, experience in statistical analysis and construction of reporting system.
Expertise in financial analysis as well as clinical informatics
Thorough knowledge of managed care utilization and quality management activities and requirements.
Experience in healthcare compliance management
Experience managing a variety of case management models using an interdisciplinary team approach.
Understands financial impact of efficient resource management.
Ability to hire, train and coach employees.
Demonstrate understanding of competency-based criteria for case management.
Ability to manage a complex, multiple hospital case management program
Health System experience is preferred