Manager, Care Management
Remote in WA, OR, UT, ID. May be required to come to the office on occasion.
The manager of care management plans, directs, and manages the activities of the care management professional and support staff. Oversees staff directly or through subordinate supervisor(s). Provides leadership to set performance standards and ensure effective and efficient execution of care management programs across all Cambia plans, including case management, disease management and care coordination. Represents the department in interactions with all levels of management, vendor partners, clients, providers, government officials, and outside consultants.
- Leads the development and execution of effective care management policies, procedures and standards.
- Oversees the implementation of policy updates or process improvements as needed to ensure quality and service excellence.
- Handles all management level responsibilities for staff, including performance reviews, employee development, hiring, firing, coaching, counseling, and retention. Develops supervisors and participates in talent management activities.
- Regularly communicates organizational objectives and team goals. Monitors results and metrics to ensure deliverables are met and compliance with department and regulatory standards. Collaborates with other leaders and across departments to resolve issues.
- Manages financial targets and department budget, authorizes expenditures, monitors workforce allocation and resources, and oversees project plans.
- In conjunction with division leadership, establishes long-term goals for department and adapts operational plans as changes occur.
- Creates visibility and support for care management programs. Develops resource materials and provides education and communication about programs to employees, providers and community stakeholders.
- Maintains clinical competency and keeps current on medical practices, procedures and industry trends.
- May develop and present educational updates to other departments.
- Oversees development and implementation of department programs. Responsible for program quality and successful outcomes of programs.
Normally to be proficient in the competencies listed above
- Ability to identify issues, opportunities, and effective solutions and collaborate with other departments to improve processes and/or results.
- Demonstrates competency in resource and project management: budgeting, organizing work, providing leadership to staff, establishing measures for success, and managing deliverables.
- Ability to develop and lead a team including: hiring, goal setting, coaching and development (including supervisors and/or employees who may be in multiple locations or work remotely).
- Ability to communicate effectively, verbally and in writing, including meeting facilitation and presentations with employer or provider groups.
- Familiar with health insurance industry trends and technology.
- Demonstrates competency in clinical case management and utilization management practices.
- Experience using population statistics and their application in care management programs.
A Manager of Case Management would have a bachelor's degree in nursing or related field, master's preferred, 7 years of healthcare or clinical care experience and 5 years of leadership experience or equivalent combination of education and experience.Required Licenses, Certifications, Registration, Etc.
- Current unrestricted Registered Nurse (RN) License in a state or territory of the United States.
- Certification as a case manager from the URAC-approved list of certifications preferred.
Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need. We've been here for members for 100 years. Regence is a nonprofit health care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. We are the largest health insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington). Each plan is an independent licensee of the Blue Cross and Blue Shield Association.
If you're seeking a career that affects change in the health care system, consider joining our team at Cambia Health Solutions. We advocate for transforming the health care system by making health care more affordable and accessible, increasing consumers' engagement in their health care decisions, and offering a diverse range of products and services that promote the health and well-being of our members. Cambia's portfolio of companies spans health care information technology and software development; retail health care; health insurance plans that carry the Blue Cross and Blue Shield brands; pharmacy benefit management; life, disability, dental, vision and other lines of protection; alternative solutions to health care access and free-standing health and wellness solutions.
This position includes 401(k), healthcare, paid time off, paid holidays, and more. For more information, please visit www.cambiahealth.com/careers/total-rewards
We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A drug screen and background check are required.
If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com