Posted 30+ days ago

Description

(RN) Complex Case Management Supervisor (Phoenix, Glendale, Pittsburgh or Plano)

You must reside in Glendale, CA or Plano, TX or Phoenix, AZ or Pittsburgh, PA to be considered for this position. The role can be work at home, but you must live in one of the four designated areas.

Position Scope:
  • Manages approximately 15-20 direct reports who are directly responsible for open, active case management files and all associated performance requirements for Cigna Health Care or CareAllies Case Management
  • Interfaces with customers as part of service marketing/account management team
  • Supports corporate, customer, product, and business initiatives.
  • Supports corporate Strategic Business Plan
  • Participates in national teams and committees, as needed.
  • Communicates with all levels of staff within Health Facilitation Centers, Home Office departments; externally with customers, medical providers, vendors, claims payors, and insurance professionals.
  • Participates in or leads projects/activities and reports progress or barriers to Manager
  • Build solid working relationships with staff, customers, other key functional areas and providers
Summary description of position:

This position has responsibility to ensure customer satisfaction through operational delivery of quality case management services. Maintains a team of Case Management staff and manages their performance and outcomes to the needs of the customer and corporate standards. Acts as liaison and collaborates with all matrix partners within the organization - Quality, Medical, Product, Systems, Training, Sales, and Health Services staff.

Major responsibilities and desired results:

  • Recruits, selects and hires qualified Case Management staff (may include referral analysts, case managers, benefit specialists, benefit analysts, and health service specialists)
  • Maintains quality improvement and ongoing personal development of all staff.
  • Supervises, monitors, and reviews performance of a Case Management team to assure that case management services are delivered promptly, cost effectively, courteously and according to Policy and Procedure, Case Management Standards, and Quality Assurance standards.
  • Manages annual and semi-annual performance evaluation process, individual discussion and feedback, and compensation for all team members.
  • Collaborates with Quality team for quality improvement opportunities and appropriate actions.
  • Partners with matrix members for the development of appropriate work plans and takes corrective action when necessary to ensure that objectives, standards, policies and procedures are met
  • Manages appropriate level of follow-up for all work plan and individual performances.
  • Acts as liaison and problem-solver between Case Managers and matrix partners.
  • Evaluates ongoing and future staff requirements/needs to meet customer, site, and corporate objectives.
  • Works with Manager to establish and ensure achievement of unit’s customer service, utilization patterns, productivity, quality, and financial goals.
  • Supports all corporate and/or national quality/certification initiatives (i.e. URAC)
  • Communicates and manages staff to QA and/or productivity standards, as applicable.
  • Supports Manager, Corporate, and Sales/Client Services in evaluating customer's service, utilization patterns, quality and financial results to assure that service delivery is within parameters defined by product and underwriting model.
  • Acts in account management and performs active customer service function for account(s); provides day-to-day contact with customer to resolve service delivery problems/issues; responds to customer requests; communicates any special customer instructions or procedures that must be followed by Case Management team.
  • May need to support the Case Manager to gain approval from customer(s) for case management service (as required), for extra contractual service requests, recommended care plan, or other needs
  • Supports needs for current and prospective customer visits, presentations and/or audits.
  • Maintains clinical knowledge and provides coaching to staff, based on area of medical expertise, when requested
  • Demonstrates evidence of continuing education in clinical and/or business management areas.
  • Advises all staff of any pertinent changes in customer, service delivery, or business functions.
  • Demonstrates leadership in sensitivity to culturally diverse situations with staff, matrix partners, clients and customers.
  • Ensures that all key metrics and financial targets are achieved.
  • Other duties as required and related to this role.
Qualifications
  • RN required
  • Management experience required
  • Case Management experience required
  • Managed care experience preferred

Qualified applicants will be considered for employment without regard to age, race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status. Need an accommodation? Email: SeeYourself@cigna.com