Director Of Care Management - Nicu

Carenational Indianapolis , IN 46208

Posted 2 weeks ago

RN Director of NICU Case Management - Managed CareREMOTE - Work from HomeJob Summary:The role of the Director of Neonatal Intensive Care Unit (NICU) Case Management is to develop leadership and staff in the pursuit of the highest quality case management for our most vulnerable members. Oversight of staff working with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of neonatal care across the continuum, including behavioral health such as Neonatal Abstinence Syndrome, and for members with high need potential. NICU staff work to ensure that members progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service. NICU staff work with mothers, guardians and providers to ensure safe and timely transitions across care settings.Position Description:The Director is responsible for being the final authority for Case Management staff. This includes questions regarding procedures, training, and processes to assure compliance with policies and procedures. Develops and implements effective and efficient standards, protocols and processes, reports and benchmarks that support and further enhances utilization management function and quality of healthcare services. Ensure provision of appropriate care through prospective, concurrent and retrospective reviews of services.
  • Understand, promote and audit the principles of Case Management to facilitate the right care at the right time in the right setting.
  • Identify trends or issues in the Case Management process that requires further evaluation for their quality or utilization implications and bring these items to the attention of the Utilization Management Director.
  • Communicate effectively and interact with the medical directors, hospitalists, provider offices, staff and health plans daily or as indicated regarding Utilization Management and referral authorization issues. Possess excellent case management skills including but not limited to, development and monitoring of care plans, post discharge calls, Vital Care referrals, hospital contracts, stop loss and DRG.
  • Take responsibility for under resourced issues and resolve workflow bottlenecks.
  • Other duties as assigned.
Background Profile:
  • Requires a valid, unrestricted state Registered Nurse (RN) license
  • Requires Bachelors Degree in Nursing (BSN) or related field. Masters degree preferred.
  • Certified in Case Management (CCM) or Utilization Management (CPUM/CPUR) preferred.
  • 5+ years Case Management experience.
  • 5+ years managerial experience and leadership of a Case Management staff in a managed care environment.
  • Familiarity with Medicaid managed care practices and policies, CHIP, and SCHIP.
  • Experience in training / teaching staffs to meet operational requirements and goals.
The Reward:EXCELLENT BENEFITS AND HIGHLY COMPETITIVE SALARY OFFERED!Work with an exceptional organization focused exclusively on promoting the health care and quality of life for its members. The forward-looking health plan has a demonstrated passion for finding innovative ways to enhance members ability to manage their own health.
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Director Of Care Management - Nicu