Case Management Supervisor Jobs

Valenz® Health simplifies the complexities of self-insurance for employers through a steadfast commitment to data transparency and decision enablement powered by its Healthcare Ecosystem Optimization Platform. Offering a strong foundation with deep roots in clinical and member advocacy, alongside decades of expertise in claim reimbursement and payment validity, integrity, and accuracy, as well as a suite of risk affinity solutions, Valenz optimizes healthcare for the provider, payer, plan, and member. By establishing “true transparency” and offering data-driven solutions that improve cost, quality, and outcomes for employers and their members, Valenz engages early and often for smarter, better, faster healthcare.

About Our Opportunity

As a Case Management Supervisor within our Care Team, you oversee and direct the work of a team of Case Managers to ensure that members receive high-quality care and are effectively managed throughout the continuum of care. You’ll also manage and work a reduced caseload.

Things You’ll Do Here:

Supervision

• Ensure timely and accurate communication with healthcare providers and payers regarding case management decisions.
• Supervise a team of Case Managers providing guidance, support, and training as needed.
• Ensure compliance with regulatory and accreditation standards such as Medicare, Medicaid, and URAC as well as CMSA’s Standards of Practice, state, local and federal laws.
• Collaborate with healthcare providers and clients to promote effective and efficient care coordination and communication across the healthcare continuum.
• Work with leadership to develop and implement case management policies, procedures, and guidelines that promote the delivery of high-quality, patient-centered care.
• Provide education and training to the internal team during the onboarding process and when the need for education and support arises.
• Participate in quality improvement initiatives and committees to promote continuous quality improvement.
• Monitor and analyze data on patient outcomes, utilization, and costs to identify opportunities for improvement.
• Conduct clinical reviews and assessments to determine patients' needs and appropriateness of care.

Case Management

• Identify cases for individual management and develop comprehensive nursing care plans, including goals.
• Educate and assist patients in understanding their condition, improve self-management, and refer them to appropriate resources.
• Evaluate care management plan goals regularly and modify as necessary.
• Apply correct data collection techniques and tools, participate in UM, QA, and complaint/grievance workflows, and follow disaster and safety plans.
• Use established evidence-based guidelines/criteria to evaluate treatment plans and goals.
• Refer cases that don't meet guidelines to appropriate clinical advisors.
• Collaborate with other departments to promote coordination and communication within the Company regarding administrative activities, quality improvement, and clinical operations.
• Maintain knowledge of regulations, funding, and community resources available to patients and their families.
• Identify potential cost savings within health plan coverage and act upon them when appropriate.
• Implement and manage care plans while maintaining contact with all involved individuals.

Reasonable accommodation may be made to enable individuals with disabilities to perform essential duties.

What You’ll Bring to the Team:

• Ability to work in a fast-paced, detailed, deadline-driven environment.
• 5+ years of experience in case management.
• Current RN or LPN in residing state.
• 2+ years of experience supervising or leading a team of case managers.
• Strong aptitude for relationship building with a highly effective communication style.
• CCM—Certified Case Manager.
• Bachelor’s degree in nursing or related.

A plus if you have:

• Health insurance experience
• Experience with hourly billing for CM services

Where You’ll Work

This role is remote.

Why You Will Love Working Here

We offer employee perks that go beyond standard benefits and compensation packages – see below!

At Valenz, our team is committed to delivering on our promise to engage early and often for smarter, better, faster healthcare. We want everyone engaged within our ecosystem to be strong, vigorous, and healthy. You’ll find limitless growth opportunities as we grow together. If you're ready to utilize your skills and passion to make a significant impact in the healthcare self-funded space, Valenz might be the perfect place for you!

Perks and Benefits

• Paid maternity and paternity leave
• Paid company holidays
• Generously subsidized company-sponsored medical, dental, and vision insurance
• Community giveback opportunities, including paid time off for philanthropic endeavors
• Company-funded HRA
• Flexible working environment
• Generous Paid Time Off
• 401K with company match and immediate vesting

At Valenz, we celebrate, support, and thrive on inclusion, for the benefit of our associates, our partners, and our products. Valenz is committed to the principle of equal employment opportunity for all associates and to providing associates with a work environment free of discrimination and harassment. All employment decisions at Valenz are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion or belief, national, social, or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. We will not tolerate discrimination or harassment based on any of these characteristics.