Job Summary

• This job manages and coordinates the supervisory staff that has accountability for the case management, medical review, utilization review, quality management and/or health education team and programs.
• The incumbent is responsible for the leadership, performance management for supervisory staff as well as company and department objectives, supporting providers in a variety of health care settings to appropriately identify members with chronic conditions and/or gaps in care.
• Develop proposals to improve overall efficiency and managed care experience, utilization, quality and clinical outcomes.

Matching Summary

Salary

Base: $94,200.00 - $151,000.00; Bonus/Equity: Not specified; Benefits: Not specified

Skills & Requirements

Key Requirements

• 5 years of experience in Clinical, Utilization, Case and/or Disease/Condition Management, Provider Operations, Health Insurance
• 3 years in a management or leadership role
• RN OR Bachelor’s or Master’s degree in Social Work
• Current State of PA RN licensure OR Current Social Work license
• Proficiency in MS Excel and enhanced data and statistical analysis skills
• Excellent interpersonal/ consensus building skills

Work Rights