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Manager, Clinical Programs / Case Mgt

Company

Premera Blue Cross
Address , Remote
Employment type FULL_TIME
Salary $82,700 - $140,700 a year
Expires 2023-10-26
Posted at 8 months ago
Job Description
Join Our Team: Do Meaningful Work and Improve People’s Lives
Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

To better serve our customers, we’re creating a culture that promotes employee growth, collaborative innovation, and inspired leadership.
Forbes ranked Premera among America’s 2023 Best Midsize Employers
because we are committed to creating an environment where employees can do their best work and where best-in-class talent comes, stays, and thrives!
The Manager, Case Management Team is a Supervisor for Case Managers. This position is responsible for the execution and implementation of Clinical Programs’ strategy and goals and the oversight of Clinical Programs’ operations. The incumbent oversees the effective integration and continuous improvement of processes and systems to meet Premera’s current and future business goals. Responsibilities also include managing and developing a team of clinical and support staff promoting their professional growth and operational effectiveness.
What you'll do:
  • Participate in the development and monitoring of budgets in accordance with department and organizational objectives.
  • Assist with the adjustment and direction of work processes to support cost and utilization variations.
  • Participate in Total Quality Management activities and processes to assure operational compliance with regulatory requirements, including NCQA, NEMIS, HCFA, and OIC.
  • Participate in the development, implementation, and monitoring of the department's performance standards, utilizing quality improvement methodologies to refine procedures.
  • Assist in the selection, training, evaluation, and development of professional paraprofessional, and administrative team members.
  • Ensure team members that can articulate the expectations of performances are invested in productivity and customer service, and can describe a positive feeling about the work environment.
  • Participate in development of Clinical Programs’ strategy and planning in accordance with company's mission and strategic goals, federal and state law and regulations, and accreditation standards.
  • As part of this role, you may be assigned internal controls derived from Premera’s internal controls framework. You will be accountable for understanding the controls assigned to you, their impacts on Premera, and to ensure that they are operating effectively.
  • Effectively manages deficits with improvement plans and consistent follow-up.
  • Foster collaborative work environment that encourages team building, facilitates cohesive synergetic performance of Care Management functions, while valuing the individual diversity and uniqueness of all employees.
  • Participate in the establishment and implementation of Care Management policies as required.
  • Build and maintain cooperative business relationships.
  • Lead Care Management teams in effective performance of job functions, which may include preauthorization, outpatient and inpatient management, case management, retrospective claim review, and delegated management oversight.
What You’ll Bring:
  • Or licensure in related healthcare discipline. (Required)
  • For nurses, required registration (e.g. RN, ARNP).
  • Experience in continuous process improvement and creative problem solving (e.g. LEAN, Synectic)
  • Experience with NCQA, URAC, or accreditation review processes
  • Advanced training in Motivational Interviewing
  • Five (5) years case management or health care experience. (Required)
  • For nursing, Associate’s Degree in Nursing plus a Bachelor’s degree; or Bachelor's degree in Nursing; for behavioral health, Master’s degree in Social Work, Marriage and Family Therapy, Mental Health Counseling, or related degree. (Required)
  • Certified in CCM (Certified Case Management) or obtain certification within 24 months of date of hire. (Required)
  • For dietitians, required certification as a nutritionist or dietician.
  • Experience training clinical and non-clinical staff
  • Three (3) years management experience. (Required)
  • Advanced degree such as Master's Degree in a Health-Related field preferred.
  • For psychologist, required board certification
  • Current state credential (e.g. licensure) that allows the professional to conduct an assessment independently as permitted within the discipline's scope of practice:
    • For nurses, required registration (e.g. RN, ARNP).
    • For behavioral health, required licensure (e.g. LMFT, LICSW, LPC, LMHC)
    • For psychologist, required board certification
    • For dietitians, required certification as a nutritionist or dietician.
    • Or licensure in related healthcare discipline. (Required)
  • For behavioral health, required licensure (e.g. LMFT, LICSW, LPC, LMHC)
  • Candidates with a RN License are highly preferred.
  • Experience managing case management teams and integrated case management model
#LI – RS1
#GD
What we offer
  • Wellness incentives, onsite services, a discount program and more
  • Generous Paid Time Off to reenergize
  • Tuition assistance for undergraduate and graduate degrees
  • Life and disability insurance
  • Medical, vision and dental coverage
  • Free parking
  • Retirement programs (401K employer match and pension plan)
Equal employment opportunity/affirmative action:
Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.
If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at [email protected] or via phone at 425-918-4785.
Premera is hiring in the following states, with some limitations based on role or city: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin .
The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience.
National Salary Range:
$82,700.00 - $140,700.00
National Plus Salary Range:
$93,500.00 - $159,000.00
  • National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska.