Case Management Manager

Responsible for total operations of Workers Compensation Case Management and Utilization Review service units which may include one or more of the following functions: staff management, operations, financial performance (profit and loss), customer service, and sales management.
Graduate of accredited school of nursing. Current RN licensure in state of operation. Three or more years of recent clinical experience, preferably in rehabilitation. National certification including CRC, CIRS, CCRN, CVE,CCM etc. (CCM preferred) Must have technical knowledge of managed care and workers compensation law, policies, and procedures in defined territory. Must have demonstrated past experience in management or supervision. Must have good computer and analytical skills.
Masters degree in business, health care, vocational rehabilitation, nursing, or other degrees related to a managed care organization. Management experience in local territory is preferred. Previous experience in the following areas is beneficial:
1) Prospective, concurrent and retrospective utilization review.
2) Experience in the clinical areas of O.R., I.C.U., C.C.U., E.R., and orthopedics.
3) Knowledge of worker's compensation claims.
4) Outpatient utilization review.
1. Responsible for financial operations, including, but not limited to: productivity, profitability,
Expense management, budgeting, billing, collections and day to day operations.
2. Responsible for quality of service provided.
3. Will support and participate in the new business development, marketing, sales and account management processes.
4. Responsible for human resources matters.
5. Must be able to travel overnight and attend meetings on occasion.
6. Requires regular and consistent attendance.
7. Comply with all safety rules and regulations during work hours in conjunction with the Injury
Illness Prevention Program ("IIPP").
8. Additional duties as required.
9. May perform daily, weekly, monthly reviews of various reports, invoices, logs and expenses.
10. Payment of bills may be delegated to a clerical person, with final approval by manager. Certain
reports may not need review prior to submission.
Depending on position/area, may be required to perform the following:
1. Oversee case management clinical activities. (Dependent on if Unit Manager is an RN.)
a. For Managers that are not RN's, the clinical oversight and direction will be performed by a designated RN with a nationally recognized certification. This could be a case management supervisor, another manager or the Vice President of Nursing and Case Management.
2. May perform case management responsibilities. (Dependent on if Unit Manager is an RN for medical case management activities or qualified for vocational case management.)
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