Nursing Supervisor, Case Management

Position Summary

The Case Management Nurse Practitioner is responsible for managing the Clinical team supporting Allied’s Clinical Case Management, Cost Containment, and Member Advocacy arms within the organization. They utilize their clinical experience and critical thinking in a collaborative process to review and facilitate appropriate health services and benefits for members, with an emphasis on understanding clinical conditions, market trends, and cost projections of conditions. They are an innovative leader with the ability to evaluate processes, drive change, and collaborate with internal and external teams, vendors, clients, and brokers.

Essential Functions

• Manage Clinical staff responsible for enhancing strategy-specific processes under the prevention, advocacy, and cost containment teams.
• Support the management of external vendor clinical staff.
• The ability to compile clinical assessment data, projections of future cost per condition, and lead discussions with internal and external teams.
• Collaborate with the Medical Management leadership team to identify trends, develop and refine strategies, and implement changes with the clinical team.
• Monitor production processes and outputs to ensure they meet standards.
• Establish and manage auditing procedures and metrics for the Clinical team to assure consistent standards are met.
• Innovate, evaluate, and processes and implement efficiencies.
• Strategize regularly with the Medical Management leadership on the management and progress of the various caseload queues, including member and claim scenarios.
• Promotes an environment of continuous improvement and collaboration while assisting in troubleshooting and resolving escalated issues.
• Supports Medical Management leadership team in developing and presenting ongoing department and organizational learning.
• Utilizes clinical skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options and services to complete clinical assessments.
• Authorizes and coordinates the required services in accordance with health plan benefits.
• Determines appropriate level of treatment by using clinical judgment and applying nationally recognized criteria.
• Engages in verbal and written correspondence with members and providers.
• Lead, coach, motivate and develop. Responsible for one-on-one meetings, performance appraisals, growth opportunities and attracting new talent.
• Clearly communicate expectations, provide employees with the training, resources, and information needed to succeed.
• Actively engage, coach, counsel and provide timely, and constructive performance feedback.
• Other duties as assigned.
  
  

Education

• Bachelor’s Degree in Nursing required
• Registered Nurse or Physician Assistant license required.
  
  

Experience & Skills

• A minimum of 7 years of Clinical Experience required.
• A minimum of 1 year of Managed Care/Discharge Planning preferred
• Demonstrated experience managing teams of employees with a variety of background and tenure required.
• Nursing and concurrent review experience, preferably from a third-party administrator, carrier, or within the healthcare industry.
• Ability to monitor and prioritize multiple deadlines and projects simultaneously.
• Experience reading, analyzing, and reviewing organizational metrics and data, preferred.
• Highly skilled in written and verbal communication, also including client focused presentations.
  
  

Position Competencies

• Accountability
• Communication
• Action Oriented
• Timely Decision Making
• Building Relationships/Shaping Culture
• Customer Focus
  
  

Physical Demands

• This is a standard desk role – long periods of sitting and working on a computer are required.
  
  

Work Environment

• Remote
  
  

The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life & Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.

Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.