Case Management Manager RN
Company: The Judge Group
Location: Monterey Park
Posted on: May 12, 2022
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Job Description:
Location: Monterey Park, CA
Description: Location: Monterey Park, CA (currently remote)Hours
per week: 40-50Schedule: M - F 8:00 am - 5:00 pm
Responsibilities
Oversees and directs the development, evaluation and implementation
of new or changing health care programs and clinical review of
medical services for the organization using the established and
approved Blue Shield Medical Policies which align with nationally
recognized standards.
Responsible for program execution and drives medical program
management for specific clinical programs.
Responsible for inventory management, monitors team performance
ensuring individual, team and compliance performance metrics are
met.
Establishes operational objectives for department or functional
area and participates with other managers to establish group
objectives.
Responsible for team, department or functional area results in
terms of planning, cost in collaboration with Sr Manager.
Ensures workflow procedures and guidelines are clearly documented
and communicated.
Interprets or may initiate changes in
guidelines/policies/procedures.
Responsible for developing and communicating established individual
and team performance metrics
Responsible for staff development, career planning, coaching and
formal performance management
May lead special projects/committees/task forces.
Required experience, skills, and knowledgeRN License in good
standing (or LVN who meets all qualifications)
7+ years of Medi-Cal Clinical Review
5+ years of management/leadership experience
2+ years of experience with California Children services
program
In-depth knowledge of the Medi-Cal program in skilled and long-term
care facilities
In-depth knowledge of the Medi-Cal program specific to CCS, DDS,
EI/ES, EPSDT
Knowledge of CMS / DHCS protocols and requirements
Understanding of NCQA / CMS / DHCS regulatory audit
requirements
Contact:kjackson@judge.com
This job and many more are available through The Judge Group. Find
us on the web at www.judge.com
Keywords: The Judge Group, Monterey Park , Case Management Manager RN, Healthcare , Monterey Park, California
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