Manager, Care Management

Location: St. Petersburg, FL

Community Health Solutions of America, LLC produces and markets top-ranked medical care management services. Our service model enhances and enriches the lives of our consumers by delivering solid quality and continuing improvement. Never content to rest on our achievements, we work every day to improve our product standards.

Summary

The Manager, Managed Care Products oversees the daily functions of the care management department.

Essential Duties and Responsibilities:

  • Maintains and ensures the confidentiality of all Personal Health Information (PHI) collected
  • Develops, implements and monitors outcome measures for training programs
  • Collects, reports, trends and analyzes elements for departmental reporting
  • Collects, reports, trends and analyzes performance standards for departmental performance reports
  • Develops, implements and monitors policies and procedures for contract and accreditation compliance
  • Serves as a liaison with members in reference to all care management processes
  • Establishes and maintain systems for effective communication throughout the care delivery system
  • Consults with Quality in departmental quality and program development initiatives
  • Processes queues and functions as Care Coordinator as needed
  • Participates in implementation of CHS Care Management Program requirements
  • Participates in QMC, PRC and other committee and organizational meetings
  • Develops staff performance objectives based on identified improvement or developmental opportunities.
  • Adheres to the policies and procedures of Community Health Solutions
  • Maintains strict confidentiality of client, company and personnel information
  • Demonstrates a strong commitment to the mission and values of the organization
  • Adheres to company attendance standards
  • Performs other duties as assigned

Qualifications:

  • A minimum of five (5) years of clinical nursing experience is required
  • A minimum of five (5) years of management experience in a managed care environment
  • Demonstrated knowledge of utilization management principles
  • Demonstrated knowledge of care management principles
  • Strong analytical, problem-solving, time management and organizational skills
  • Must be detail-oriented, able to exercise good judgment and work well independently Able to multi-task and follow through on assignments to completion
  • Ability to prioritize work with tight schedules and target dates
  • Must meet performance standards including attendance and punctuality

Education and/or Experience:

A Bachelor’s degree in a health related field is strongly preferred.

Certificates, Licenses, Registrations:

  • Certified Case Management (CCM) is preferred or other certifications recognized by URAC
  • Current Registered Nurse license in the state of Florida and other states as required

Computer Skills:

Proficiency using software programs such as MS Word, ACCESS, PowerPoint, Excel, and Outlook.

Environmental Factors/Physical Demands:

While performing the duties of this job, the employee is regularly required to have the ability to maintain active customer and employee communication; access, input and retrieve information from the computer system; enter alpha-numeric data into a computerized system often while listening on the telephone. May be subject to repetitive motion such as typing, data entry and vision to monitor. May be subject to bending, reaching, kneeling, stooping and lifting up to thirty (30) pounds.

To apply, please forward resume to careers@chsamerica.com

Tell a friend