Manager, Medical Case Management

Overview

PRIMARY PURPOSE:

The RN Branch Manager for telephonic case management services will oversee operations as well as a team of experienced worker’s compensation nurse case managers. The ideal candidate will have a minimum of three (3) or more years’ experience overseeing a nursing claims management program as well as in-depth understanding of worker’s compensation injury claims and utilization management review programs. The Manager will lead the nurse case management team to strategize with claim professionals in management of medical and disability exposure, delivering quality telephonic case management to proactively drive best in class outcomes including appropriate medical treatment and engagement of the injured worker to achieve a safe and reasonable return to work. This position requires interaction with physicians, other medical providers, claims professionals, supervision, injured employees and employers.

Responsibilities

• Manage, develop and direct staff to ensure the delivery of high-quality managed care services involving medical and disability case management achieving best in class outcomes for our customers and their injured workers.
• Responsible for all oversight of operational and administrative activities within the department/unit.
• Ensure staff adheres to established standards and protocols to effectively manage assigned caseload of medical and disability cases to evaluate and assess for optimal injured worker outcomes, continuous improvement opportunities, assure key performance metrics are met and/or exceeded.
• Recruits, coaches, develops staff to broaden and strengthen the skill sets to further promote talent within the organization both laterally and management opportunities, creating a high performing results-oriented staff.
• Management of performance management programs including communication of objectives, providing on-going coaching and conducting performance reviews, and as applicable initiate progressive disciplinary actions.
• Manages salary (and no-salary) budgets, makes recommendations to Zonal Director and leadership concerning promotions, terminations, and staffing authorizations.
• Acts as a technical expert and resource for staff which includes maintaining the highest level of authority within the department/unit specific office. Technical expertise and resource knowledge for all levels of care coordination from low to high severity or complex cases. Appropriately refers issues/concerns outside of authority level to Zonal Management level.
• Ensures appropriate compliance with all legislation, corporate policies, and programs.
• Assist Zonal Management and other departments with new business and/or renewal presentations and periodic claims service reviews.
• Implements new and revised policies and procedures.
• Performs additional duties and/or is assigned special projects as requested.

Qualifications

Education & Licensing

• Ability to develop, manage and direct an office/unit operation and effectively communicate operational procedures to field/unit staff.
• Demonstrated leadership and innovation in achieving results.
• Advanced knowledge of principles and methods pertaining to the specific department, knowledge of department management practices, company operations (i.e. other staff and line departments), and policies.
• Active unrestricted RN license in a state or territory of the United States with eligibility to get and/or renew a multistate license is required.
• Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work experience preferred.
• National Certification in case management OR the ability to obtain certification within 24 months of employment is required. 
• Written and verbal fluency in Spanish and English preferred.

Experience

• Overall five (5) years of related case management experience or equivalent combination of education and case management experience required to include three (3) years of management or leadership role experience in case management.  
• Preferred previous clinical experience orthopedic, emergency room, critical care, home care or rehab experience.

Skills & Knowledge: 

• Knowledge of workers' compensation laws and regulations 
• Knowledge of case management practice
• Knowledge of the nature and extent of injuries, periods of disability, and treatment needed
• Knowledge of URAC standards, ODG, Utilization review, state workers compensation guidelines
• Knowledge of pharmaceuticals to treat pain, pain management process, drug rehabilitationKnowledge of behavioral health Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Leadership/management/motivational skills Analytic and interpretive skills Strong organizational skills Excellent interpersonal and negotiation  skills Ability to work in a team environment Ability to meet or exceed Performance Competencies 

The salary range for this role is $108,000-$120,000/year. This range is only applicable for jobs to be performed in New York. Base pay offered may vary depending on, but not limited to education, experience, skills, geographic location, travel requirements, sales or revenue-based metrics. This range may be modified in the future.

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What We Offer

AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.

AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.

AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.