The Central Arizona Chapter of CMSA is pleased to introduce a site where employers may post job opportunities for case managers. Case managers may also use this page to search for open positions of interest to them.
RN Director of Medical Management- Managed Care Health Plan, Phoenix, AZ

CORE FUNCTIONS: Assure that programs for medical management operate in a manner that is fiscally responsible and compliant with state and federal contractual requirements and regulations of the managed care health plan.

ESSENTIAL Job Functions:
Directs daily operations of the Department (Case Management, Utilization Management, Prior Authorization) including: budget preparation, hiring and training of staff, supervision of management staff, staff evaluation and performance appraisals. Assures completion of activities related to proper oversight and management of members through-out the network. Tracks/trends activities and outcomes to identify opportunities to improve service and quality of care. Under the direction of the VP of Medical and Case Management Services, develops, implements, and oversees the UM/CCM Program, Annual UM/CCM Work Plans, Annual UM/CCM Evaluations. Assures that the annual UM program descriptions, work plan and evaluations are prepared timely for the review of the VP, Medical and Case Management Services prior to submission to regulatory agencies. Achieves financial objectives by preparing an annual budget, approving appropriate expenditures, analyzing variances, and initiating corrective action. Develops and implements support tools and documentation to assist in Medical Management initiatives. Promotes compliance with all regulatory and accreditation standards including: AHCCCS, CMS, Department of Managed Health Care (DMHC), Department of Health Services (DHS), the National Commission of Quality Assurance (NCQA); serve as resource for other departments. Maintains department in a state of readiness and compliance for site visits from regulatory agencies. Serves as department representative during regulatory agency site visit. Responsible for developing and fulfilling corrective action plans related to identified deficiencies. Assures that Policy and Procedures are created or updated to include new benefits or standards and oversees the annual P&P update review with the Compliance Department. Facilitates internal committee structures by overseeing agenda and minute preparation, meeting notification and reporting on progress toward UM work plans. Provides utilization reports by collaborating with other departments for information. Collects utilization data, monitors and reports on key UM indicators and benchmarks, tracks and trends, conducts analyses and makes recommendations to improve results. Accountable for the successful implementation of the SCAN strategic plan initiatives related to the Medical Management infrastructure. This includes collaboration on interdisciplinary work teams to assure deliverables and due dates are met. Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies. Contributes to team effort by accomplishing related.

· PREFERRED QUALIFICATIONS:

· AHCCCS/Medicare managed care background preferred. Bachelors in nursing preferred. Master’s degree preferred in healthcare administration, MBA or MPH. Certified Professional in Health Care Quality (CPHQ) desired. Through knowledge of NCQA standards and CMS regulations. Arizona licensed registered nurse or nurse practitioner required. Case Management Certification preferred. Bachelor’s degree required. Working knowledge of Milliman and InterQual criteria preferred. Strong verbal and written communication skills. Proficiency in MS Word and Excel.

RN Manager of Concurrent Review, Managed Care Health Plan, Phoenix, AZ

**NOTE: Please only apply if you have experience in leadership within a Utilization Management department of a Health Plan.

The Manager of Concurrent Review has responsibility to supervise all Utilization Review Nurses for the busy medical management department. The Utilization Review Nurses perform medical on-site utilization review, initiates and coordinates discharge planning in acute/sub-acute settings for assigned facilities. Primary duties include: Supervising the Utilization Review Nurses – performing medical on-site utilization review. Initiating and coordinating discharge planning in acute/sub-acute settings for assigned facilities. Providing oversight of operational components for concurrent review program, providing leadership to clinical and non-clinical staff. Developing policies and procedures (desktops) and work plans as related to AHCCCS/CMS and updates annually. Conducting chart audits of staff to review appropriate and timely documentation; completes follow-up as necessary. Developing and maintaining training manuals for all concurrent review staff. Training staff when new staff begins and conduct follow-up, as needed. Implementing and maintaining inpatient data entry program that results in accurate and timely payment of claims. Ensuring daily bed reports are current and accurate. Conducting annual interrater reliability testing for concurrent review nurses and anyone using utilization criteria in decision-making. Developing corrective action plans for staff as appropriate.

Minimum Requirements:
Bachelors of Science in Nursing degree or equivalent experience required
5 years of Concurrent Review/Case Management experience, with management experience in managed care required. Medicaid (AHCCCS/Medicaid and Medicare Knowledge)
Current Registered Nurse license in the state of Arizona
Knowledge of Microsoft Office Programs including Outlook, Word and Excel

Preferred Qualifications:
CCM Certification preferred

RN Supervisor of Complex Case Management, Managed Care Health Plan, Phoenix, AZ

**Note: Candidate must have prior experience in Health Plan Medical Management as a Nurse Leader to qualify.

The role of the Supervisor for the Medical Management department will be to oversee the job results of the complex case management staff and disease management nurses. The supervisor is responsible for compliance with all clinical standards, regulatory requirements, and various internal policies and procedures.

Job Responsibilities:

Facilitate the day to day operations by assuring staff is performing case management functions and compliant with all regulatory requirements, clinical standards and internal policies and procedures. Perform independently and meet required regulatory requirements, deadlines and all plan requirements related to case management activities in accordance with policies and procedures. Collaborates with Manager and Medical Director to develop, edit and analyze reports, policies and procedures, initiatives and goals for the department. Supports special projects by performing job responsibilities related to the clinical and administrative workflow functions. Lead, develop and coach all direct reports in relationship to day-to-day activities and career goals. Collaborate with Network Management, Utilization Management and Case Management to identify and meet member’s needs and achieve appropriate level of care and services. Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies. Participate in the development and on-going components of the Disease Management Program and other related programs. Contribute to team effort by accomplishing related results as needed.

QUALIFICATIONS: The qualified Nurse Candidate needs strong Medicare, Medicaid (AHCCCS) and case management experience with senior/Medicare population required. Experience with prior authorization and utilization review preferred. Current Arizona RN license in good standing, required. Bachelor’s degree, or equivalent experience. Strong interpersonal, verbal and written communication skills. Proficiency with MS Office (Excel, Word, Outlook) required.4-6 years supervisory experience in a managed care setting. .

To apply for these or any other positions, please visit careers.carenationalservices.com or contact me directly!

Steve Thornley, CSP, Senior Consultant

CareNational Healthcare Services

480-336-2526 | Direct

480-275-7070 | Mobile

800-974-4828 | Toll Free

888-892-1844 | Toll Free Fax

steve@carenationalservices.com

carenationalservices.com