Other Great Industries
At least 5 year(s)
Monitors the activity of the case management staff for timeliness with regulatory compliance and provides clinical support and assistance as needed. Provide direction with problem identification, problem solving and development of new processes for the staff.
MAJOR DUTIES AND RESPONSIBILITIES:
- Provides direct supervision and training and assures coverage of the telephonic nurse case managers and administrative staff.
- Oversee the distribution of new case referrals.
- Oversees and drives to departmental goals in timely and appropriate handling of pre-certification processing, file handling, IME referrals, appropriate closures and optimal customer service.
- Interacts with medical providers and patients on claim inquiries.
- Interfaces with account representatives to insure open line of communication regarding case management processes.
- Responsible for staff time, attendance and approval of scheduled time off.
- Responsible to conduct performance evaluations of staff.
- Provide direction with problem identification, problem solving, and development of new processes as needed.
- Quality Assurance calibration, best practice to direct staff performance.
- Assurances compliance with State regulatory statutes and Medical Standards.
- Assures case management services are provided with in CSMA Standards of Care.
- Provide daily statistics on staff production.
- Assess the learning needs of the case management staff and facilitate training with Nurse Educator and/or training department.
- Ensure smooth workflow processes among the case management staff and all AIS departments.
- Oversee the application of client plans and AICRA.
Concentra's Data Protection Commitment
* Concentra is committed to protect patient data and to ensure privacy of personal and medical information.
* Every Concentra colleague has the responsibility to adhere to data protection principles.
* If a colleague's role includes handling or processing sensitive data, role-specific policies and requirements apply to ensure the protection of patient information.
Strong problem solving, critical thinking and interpersonal skills.
Excellent written and verbal communication skills, including conflict management
Knowledge of computers, Word and Window NT, Excel
JOB RELEVANT EXPERIENCE:
- Minimum 5 years clinical experience
- Prior supervisory or management experience in health care or insurance environment
- Minimum 1 year prior case management experience dealing with PIP, Workman’s Compensation, managed care, home care or rehabilitation preferred
- Previous hospital experience may include Critical Care, Emergency Room, Orthopedics
- Knowledge of discharge planning and home care
Office environment (Iselin, NJ office) with potential for work from home rotation
Registered Nurse – Licensed and residing in New Jersey with an active license in good standing