Description:
It's a great time to put the strength of Coventry Health Care behind your career! Coventry is currently recruiting for projected openings in our Coventry Health Care of the Carolinas health plan related to our anticipated entrance into the Government health insurance exchange program. Start dates will be in the fall, once participation in the exchanges is approved by the Government.Coventry Health Care provides a full range of risk and fee-based managed care products and services to a broad cross section of employer and government-funded groups, government agencies, and other insurance carriers and administrators.
GENERAL SUMMARY
Responsible for the daily supervision of the Complex Case Management team. Serves in an active managerial role to assist in the development, implementation, and evaluation of the utilization management process.
ESSENTIAL RESPONSIBILITIES
- Provides oversight and direction to the specific members in the area of complex case management; including, staffing, training, monitoring, and evaluating.
- Reviews the timeliness, appropriateness, and medical necessity of the utilization processes performed by the staff. Prepares reports detailing the monitored activities.
- Actively participates in the development, implementation, and oversight of the department's activities; serves in an adjunct role for policy and procedure development and implementation.
- Assists in the identification of issues which may adversely impact the attainment of department goals/initiatives (i.e., inpatient bed days per thousand, outpatient surgery utilization, etc.)
- Collaborates with other departments to educate providers/vendors and members regarding network providers/specialists benefits and utilization management policies and procedures.
- Attends meetings with internal workgroups and external business associates.
- Assists in the identification and triage of potential quality improvement issues and is responsible for assuring that these issues are reported to the Quality Improvement department.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- Registered nurse with current state RN license.
- Bachelor's degree OR certification as a Case Manager OR professional certification in a clinical specialty and previous (at least 3 years) experience as a Case Manager.
- Successful acquisition of case management certification is required if directly supervising the case management process for 3 or more years.
- Significant experience (usually 2+ years) in utilization management.
- Significant clinical experience (usually 3+ years).
- Previous supervisory experience (usually 2+ years).
- Regular local travel may be required.Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Professionals
Primary Location: Morrisville, NC, US
Other Locations: Charlotte-North Carolina-United States,
Organization: 28000 - Coventry Health Care of the Carolinas, Inc
Schedule: Full-time
Job Posting: 2013-08-19 00:00:00.0
Job ID: 1312688
It's a great time to put the strength of Coventry Health Care behind your career! Coventry is currently recruiting for projected openings in our Coventry Health Care of the Carolinas health plan related to our anticipated entrance into the Government health insurance exchange program. Start dates will be in the fall, once participation in the exchanges is approved by the Government.Coventry Health Care provides a full range of risk and fee-based managed care products and services to a broad cross section of employer and government-funded groups, government agencies, and other insurance carriers and administrators.
GENERAL SUMMARY
Responsible for the daily supervision of the Complex Case Management team. Serves in an active managerial role to assist in the development, implementation, and evaluation of the utilization management process.
ESSENTIAL RESPONSIBILITIES
- Provides oversight and direction to the specific members in the area of complex case management; including, staffing, training, monitoring, and evaluating.
- Reviews the timeliness, appropriateness, and medical necessity of the utilization processes performed by the staff. Prepares reports detailing the monitored activities.
- Actively participates in the development, implementation, and oversight of the department's activities; serves in an adjunct role for policy and procedure development and implementation.
- Assists in the identification of issues which may adversely impact the attainment of department goals/initiatives (i.e., inpatient bed days per thousand, outpatient surgery utilization, etc.)
- Collaborates with other departments to educate providers/vendors and members regarding network providers/specialists benefits and utilization management policies and procedures.
- Attends meetings with internal workgroups and external business associates.
- Assists in the identification and triage of potential quality improvement issues and is responsible for assuring that these issues are reported to the Quality Improvement department.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- Registered nurse with current state RN license.
- Bachelor's degree OR certification as a Case Manager OR professional certification in a clinical specialty and previous (at least 3 years) experience as a Case Manager.
- Successful acquisition of case management certification is required if directly supervising the case management process for 3 or more years.
- Significant experience (usually 2+ years) in utilization management.
- Significant clinical experience (usually 3+ years).
- Previous supervisory experience (usually 2+ years).
- Regular local travel may be required.Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Professionals
Primary Location: Morrisville, NC, US
Other Locations: Charlotte-North Carolina-United States,
Organization: 28000 - Coventry Health Care of the Carolinas, Inc
Schedule: Full-time
Job Posting: 2013-08-19 00:00:00.0
Job ID: 1312688