Job Title Manager, Nursing
Business Function Nursing and Healthcare Professionals
Department HCS-Ops-Madison Park
Position Location Winston Salem
Major Responsibilities Provides the highest quality of effective, proactive and professional services to staff, members and providers in all aspects of Clinical Determinations, Case Management Services or Case Management of Appeals. Functions in the primary role as oversight for the function to include: staffing, auditing, project management, staff development, quality management, as well as training and development.
* Manage the operational performance of one or more functions of the department to ensure performance standards are met and in compliance with state and federal regulations.
* Initiate service initiatives in order to facilitate and promote quality, cost effective outcomes and minimize the impact of the fragmentation of health care delivery on the member.
* Manage the day to day planning and direction of all clinical and non-clinical staff and report on productivity and performance of staff.
* Collaborate in the management of programs to include evaluation, coordination, negotiation and documentation of department policies, procedures, and processes.
* Facilitate complex clinical and financial decision making by presenting thoroughly analyzed cases requiring high administrative approval or intervention.
* Oversee an integrated continuous quality improvement process to assure high quality care, customer satisfaction and contribution to financial performance.
* Provide guidance to staff in resolving problematic situations with beneficiaries, families, physicians and external entities.
* Manage investigations and respond to all client and provider complaints.
* Meet and collaborate with physicians regarding specific cases and troubleshoots high profile cases.
* Assist Director with budgets and has a good working knowledge of budget and the budget tool.
* Provide leadership, coaching and mentoring to department staff.
* Ensure processes, metrics and control environments are well defined and documented.
Requirements . RN with valid NC license required.
. 5 years clinical experience in a health care environment.
. 3 years direct supervisory experience or leadership experience.
. Knowledge of Windows and Microsoft Office required.
Additional Critical Skills & Knowledge Needed for Job . Comprehensive knowledge of laws, regulations and professional standards of care management practice in a managed care setting is strongly preferred.
. BSN preferred.
. Excellent negotiation skills.
. Excellent problem solving skills.
. Effective verbal and written communications skills.
. Ability to develop and maintain collaborative relationships with internal and external customers.
. Proven ability to effectively communicate orally and in writing detailed and complex information at all levels that possess varying degrees of comprehension.
. Facilitation and presentation skills.
. Demonstrated analytical thinking skills. Ability to track and trend data, identify issues, recommend and implement solutions after thorough risk assessment. Data driven decision making skills.
. Certified Professional Coder (CPC) preferred.
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