Case Management Manager RN

Company: The Judge Group
Location: Monterey Park
Posted on: May 12, 2022

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