Manager RN (Medical Unit - Government DSNP Unit)
A Manager within the medical department is responsible for overseeing day to day operation of the clinical staff within their designated area/line of business.
They are responsible for ensuring proper staffing levels, work assignments, performance evaluation of staff, serving as a subject matter expert on benefits, policies and operational procedures within their line of business and ensuring that all medical operations are consistent with The Health Plan operational standards.
- Registered Nurse with at least five (5) years experience. Two (2) of those years may be work experience as nurse's aide or LPN.
- Must have critical care or other acute care experience.
- Active Ohio and West Virginia licensure which must be maintained throughout employment, including compliance with State Boards of Nursing continuing education policy. Other licensure required as company expansion warrants
- Experience with care coordination, discharge planning, clinical documentation, and utilization review.
- Experience with care navigation workflow system such as Case Tracker.
- Knowledge of InterQual criteria and patient status changes.
- Strong communication and leadership skills.
- Knowledge of accreditation standards, federal and state standards/regulations.
- Considerable knowledge of clinical service policies and procedures.
- Ability to analyze data and employ approved management techniques and statistical tools to obtain maximum effectiveness, efficiency and information.
- Ability to interpret established policies into operating procedures and to execute complex case navigation programs.
- Ability to coordinate effectively various functions and activities for maximum cooperation and efficiency.
- Ability to direct, instruct and advise staff in the approved methods, procedures and practices employed in effective complex case navigation administration.
- Ability to receive and effectively react to day-to-day problems presented by staff as well as others.
- Effective organizational, oral and written communications skills, problem solving, program development, computer skills, strong leadership and team building skills.
- Ability to work with a variety of disciplines and levels of staff across departments.
- Ability to establish priorities, meet deadlines, develop and manage the department's productivity in the management of work assignments.
- Ability to form positive, collaborative relationships with members of the management team.
- Certification in managed care, case management or related clinical certification desirable.
- Utilization Management, Quality Improvement or Disease Management experience desirable.
- Active licensure in other states as requested.