Manager, Case Management

Workforce Classification:

Telecommuter

Join Our Team: Do Meaningful Work and Improve People’s Lives

Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

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Please note this position aligns to PST business hours.

The Manager, Case Management Teamis a Supervisor for Case Managers. This position is responsible for the execution and implementation of Clinical Programs’ strategy and goals and the oversight of Clinical Programs’ operations. The incumbent oversees the effective integration and continuous improvement of processes and systems to meet Premera’s current and future business goals. Responsibilities also include managing and developing a team of clinical and support staff promoting their professional growth and operational effectiveness.

What you'll do:

• Participate in development of Clinical Programs’ strategy and planning in accordance with company's mission and strategic goals, federal and state law and regulations, and accreditation standards.
• Assist in the selection, training, evaluation, and development of professional paraprofessional, and administrative team members.
• Lead Care Management teams in effective performance of job functions, which may include preauthorization, outpatient and inpatient management, case management, retrospective claim review, and delegated management oversight.
• Participate in the development and monitoring of budgets in accordance with department and organizational objectives.
• Assist with the adjustment and direction of work processes to support cost and utilization variations.
• Participate in the development, implementation, and monitoring of the department's performance standards, utilizing quality improvement methodologies to refine procedures.
• Participate in the establishment and implementation of Care Management policies as required.
• Foster collaborative work environment that encourages team building, facilitates cohesive synergetic performance of Care Management functions, while valuing the individual diversity and uniqueness of all employees.
• Build and maintain cooperative business relationships.
• Participate in Total Quality Management activities and processes to assure operational compliance with regulatory requirements, including NCQA, NEMIS, HCFA, and OIC.
• Ensure team members that can articulate the expectations of performances are invested in productivity and customer service, and can describe a positive feeling about the work environment.
• Effectively manages deficits with improvement plans and consistent follow-up.
• As part of this role, you may be assigned internal controls derived from Premera’s internal controls framework. You will be accountable for understanding the controls assigned to you, their impacts on Premera, and to ensure that they are operating effectively.

What You’ll Bring:

• Candidates with a RN License are highly preferred.
• Current state credential (e.g. licensure) that allows the professional to conduct an assessment independently as permitted within the discipline's scope of practice (Required):
  • For nurses, required registration (e.g. RN, ARNP).
  • For behavioral health, required licensure (e.g. LMFT, LICSW, LPC, LMHC)
  • For psychologist, required board certification
  • For dietitians, required certification as a nutritionist or dietician
  • Or licensure in related healthcare discipline
• Certified in CCM (Certified Case Management) or obtain certification within 24 months of date of hire. (Required)
• Five (5) years case management or health care experience. (Required)
• Three (3) years management experience. (Required)
• Advanced degree such as Master's Degree in a Health-Related field preferred.
• Experience with NCQA, URAC, or accreditation review processes
• Experience in