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Manager, Clinical & Non-Clinical Care Management Teams-Remote, home based

Company: Doeker Resource Partners
Location: Charlottesville
Posted on: January 10, 2022

Job Description:

(Only QUALIFIED Healthcare Professionals accepted) Community Health-Nurse Manager - Title:Manager, Clinical & Non-Clinical Care Management Teams-Remote, home based

Location: Anywhere within 200 miles of Washington, DC

Position Description

Provide operational management of clinical staff who provide utilization review, and-or specialty reviews.
Provide operational management of non-clinical staff who provide customer service assistance to internal and external customers, enter document request for utilization review and other medical management services, quality audit validation to identify suspected, fraud, waste, abuse, PHI violation, member and provider eligibility.
Develop, implement, and maintain departmental policies and procedures, staffing protocols, training programs, quality management programs to include quality assurance reviews & reporting and department budgets.
Ensure that department fully meets all required legal, contractual and accreditation standards as well as compliance with corporate policies.
Participate in business-product development, proposals, and customer relations activities. Conduct prospective, concurrent, and-or retrospective utilization management reviews, as applicable.
Ensures the integrity and high quality of utilization management services

Efficiently and effectively manages financial responsibilities

Complies with policies and procedures, administrative assignments, and other projects

Required Skills

Intermediate MS Office Suite proficiency
Working knowledge of Medicaid, or commercial insurance preferred
Demonstrates ability of sound clinical judgment and administrative leadership skills
Ability to understand, organize and delegate complex work tasks to staff
Required Experience

BA-BS in a related field; equivalent combination of education and-or work experience in related field may be substituted
Current, active, unrestricted RN licensure in the (District of Columbia and Maryland) required (willing to obtain DC RN Lic)
5 years of utilization-case management experience
2 years of management experience, including financial management
Our client is a national, privately held, non-profit, financially stable company providing healthcare quality, process improvement and safety project services with federal and state organizations such as Medicare, Medicaid and Indian Health Services. They are viewed as a major player in this industry.

The is a permanent, full-time position with a market-based salary, excellent corporate benefits including full health, dental, vision (my client pays 75% of premiums for both the employer and their dependents!), 3% matching retirement, PTO and much more. In addition, they offer the PSLF-Public Student Loan Forgiveness.

Let's schedule a call to specifically discuss your career direction, our client and the position in depth. I look forward to speaking with you.


Gene Doeker-President

Toll-Free 1-877-2DOEKER, 1-877-236-3537
Direct 1-318-703-3795
Mobile 1-318-207-7321
Fax 1-866-945-9598

Keywords: Doeker Resource Partners, Charlottesville , Manager, Clinical & Non-Clinical Care Management Teams-Remote, home based, Executive , Charlottesville, Virginia

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