Complex Case Manager
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The Complex Case Manager works within the framework of company’s multiple products to establish collaborative processes that promote quality and cost effective care.
Case Management activities require interfacing with members, providers, clinics, medical directors, intake staff, and other departments within the company.
Performance is primarily measured by quality audits, regulatory requirements, and meeting case-management industry benchmarks.
General working knowledge of how various health care services link together (the health care continuum).
Experience working with multiple age groups, medical, surgical background and a generalized level of understanding across specialty care areas.
Accomplished in communication with physicians and health care providers.
Excellent internal and external customer service skills, strong decision making skills.
Ability to think creatively and be comfortable negotiating and accessing resources.
Excellent verbal and written skills and the ability to present in a group setting.
Experience managing multiple computer systems and tools.
Ability to work independently in a fluid, ever-changing environment.
Ability to thrive in fast-paced setting and make decisions under stress and manage multiple complex issues on a daily basis.
Education Level: Bachelor’s Degree in nursing – preferred or equivalent nursing experience.
Years of experience required: 5 years case management, utilization management or hospital care coordination experience.
Specific types of experience required:
-Certified Case Manager (CCM) preferred
-Managed care experience preferred
-Minimum 5 years of clinical/acute care experience