Manager, Case Management
Are you an experienced Case Manager
with proven leadership ability?
Do you value autonomy, creativity & the ability to effect change?
We want to speak to you about a career at HMA.
HMA is a Third Party Administrator conveniently located in Bellevue with a dynamic, innovative Health Services department currently staffed by 15 RNs plus 9 other allied health personnel. We are a wholly owned subsidiary of Regence BS, and have been here for over 25 years. HMA serves over 100,000 employee lives on behalf our self-insured group health plans. We offer a generous benefit package, competitive salaries, profit sharing, a friendly welcoming culture and the opportunity to work from home. Here is your chance to work with a vibrant, fun and knowledgeable team of RN’s with diverse clinical backgrounds.
The Manager, Case Management performs all management functions of the Medical Case Managers and the Case Management program, as well as the Hospital Bill Review program; project work as required and assigned by the Director of Health Services; development and review of P&Ps; and daily management of the Case Management and Hospital Bill Review unit staff, including but not limited to approval of absences; preparation and delivery of performance reviews; recommendations regarding hiring, terminations or job changes; case management program and Hospital Bill review program development and oversight; mentoring, teaching and training of staff; and interactions with external clients and brokers as needed.
- Ensure daily case management policies/procedures and functions are being carried out, including adherence to Standards of Practice for Case Management, initiating training and teaching when required
- Provide direction to case management staff regarding information gathering, interaction with external customers/policyholders, and internal customers or departments.
- Provide direction to hospital bill review staff regarding line by line bill reviews, adverse determinations and appeals.
- Provide guidance to health services staff, plan administrators, brokers and excess loss carriers regarding complex cases, and descriptions of medical service needs
- Ensure daily utilization review policies/procedures and functions are being carried out when done in conjunction with the case management of patients.
- Oversee the quality of work completed by the case management nurses and the hospital bill review team; investigate possible sources of medical information to assist in reviews.
- Ensure daily compliance with HIPAA and DOL regulations
- Perform quality audits for case management and hospital bill review staff, and provide correction or education to staff as needed.
- Develop, review and implement new policies and procedures as needed. Continuously review existing policies and procedures to ensure accurate, up to date instructions
- Other duties as assigned by Director
Successful Candidate will have:
- Current WA State RN license.
- CCM certification required.5 years of experience in medical case management.
- 2 years of experience in payer based utilization review.
- 2 years of previous management or leadership experience.
- Extensive CM and Utilization Review process knowledge.
- Extensive knowledge of medical procedure and insurance terminology.
- Exceptional communication, presentation and interpersonal skills.
- Team player able to work in a self-directed position involving a high degree of complexity.
- Proficient with MS Office suite and Excel.
Healthcare Management Administrators (HMA) believes in delivering superior value to our many self-funded Northwest clients by combining competitive rates with superior service. If you would like to learn more about our organization, please E-mail your resume, cover letter and salary history. Faxed resumes are welcome at 305/574-0443. Be sure to visit our website at www.accesshma.com.