Director, Case Management - Wheeling - The Health Plan of West Virginia Inc

    The Health Plan of West Virginia Inc
    The Health Plan of West Virginia Inc Wheeling

    13 hours ago

    Default job background
    Full time
    Description

    Job Overview

    The Director of Case Management is responsible for leading the development and implementation of care continuum programs to ensure high-quality, member-centric care. This role oversees medical and Care Continuum operations, providing direct supervision to managers and supervisors.

    Key Responsibilities:

    1. Develops and monitors medical management staff care continuum training program.
    2. Participates on all clinical services committees.
    3. Develops and continually reviews care continuum processes, policies, and procedures within the department.
    4. Enhances system of management reporting and metrics for productivity, adherence, and outcome measurements.
    5. Ensures department optimizes care continuum workflow efficiencies to meet company objectives.
    6. Maintains compliance with applicable internal policies and procedures as well as regulatory agency requirements (CMS, BMS, NCQA).
    7. Responsible for medical management/behavioral health annual risk assessment related to care continuum programs.
    8. Collaborates with cross-functional teams to align initiatives with organizational goals.

    Requirements:

    • Registered Nurse with a minimum of 5 years clinical experience.
    • At least two years of experience in a management capacity.
    • Minimum of a Bachelor's of Science degree in Nursing or willingness to obtain within 2 years of hire.
    • Holds active and unencumbered Ohio or West Virginia multi-state registered nurse license.
    • Minimum of five years in a managed care organization.

    Estimated Salary: $120,000 - $180,000 per year

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