Manager RN (Medical Unit - Government DSNP Unit)

Manager RN (Medical Unit - Government DSNP Unit)
Wheeling, WV
Full-Time
Clinical Services
Director of Medical & Behavioral Health Management

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.

  1. Registered Nurse with at least five (5) years experience. Two (2) of those years may be work experience as nurse's aide or LPN. 
  2. Must have critical care or other acute care experience.
  3. 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
  4. Experience with care coordination, discharge planning, clinical documentation, and utilization review.
  5. Experience with care navigation workflow system such as Case Tracker.
  6. Knowledge of InterQual criteria and patient status changes.
  7. Strong communication and leadership skills.
  8. Knowledge of accreditation standards, federal and  state standards/regulations.
  9. Considerable knowledge of clinical service policies and procedures.
  10. Ability to analyze data and employ approved management techniques and statistical tools to obtain maximum effectiveness, efficiency and information.
  11. Ability to interpret established policies into operating procedures and to execute complex case navigation programs.
  12. Ability to coordinate effectively various functions and activities for maximum cooperation and efficiency.
  13. Ability to direct, instruct and advise staff in the approved methods, procedures and practices employed in effective complex case navigation administration.
  14. Ability to receive and effectively react to day-to-day problems presented by staff as well as others.
  15. Effective organizational, oral and written communications skills, problem solving, program development, computer skills, strong leadership and team building skills.
  16. Ability to work with a variety of disciplines and levels of staff across departments.
  17. Ability to establish priorities, meet deadlines, develop and manage the department's productivity  in the management of work assignments.
  18. Ability to form positive, collaborative relationships with members of the management team.

  1. Certification in managed care, case management or related clinical certification desirable.
  2. Utilization Management, Quality Improvement or Disease Management experience desirable.
  3. Active licensure in other states as requested.

Employment Documents

EEO

Or, if you are interested in a fast-paced career with us, please send resume with salary requirements to:

HR Department 
1110 Main Street
Wheeling, WV 26003-2704
hr@healthplan.org