Health Care Management Systems (HCMS) Manager- Remote MUST reside in Indiana

ZipRecruiter; Indianapolis (IN); Remote; USD 60,000 - 100,000; Full time

Job summary

An established industry player is seeking a Health Care Manager to lead a dynamic team focused on case management for members with complex health needs. In this role, you'll coordinate service delivery, assess member needs, and partner with providers to set achievable goals. Your expertise in health care management and project oversight will be crucial in ensuring compliance with quality standards and enhancing customer service. If you have a strong background in health care and a passion for improving outcomes, this is an exciting opportunity to make a significant impact.

Qualifications

• 5+ years of experience in Health Care Management required.
• Current active unrestricted RN, PA, LSW, or equivalent license required.

Responsibilities

• Manage and oversee case finding and coordination for comorbid conditions.
• Evaluate medical and mental health services for cost containment.

Skills

Health Care Management

Project Management

Contract Interpretation

Regulatory Compliance

Education

Bachelor's Degree

Registered Nurse License

Licensed Social Worker

Job description

Job DescriptionJob DescriptionDescription:

• Manages and oversees the team responsible for case finding and coordinating cases that involve comorbid conditions.
• Coordinate service delivery to include member assessment of physical and psychological factors.
• Partners with providers to establish short- and long-term goals that meet the member’s needs, functional abilities, and referral sources' benefit systems and cost-benefit analysis.
• Evaluates medical, mental health, and substance abuse services for cost containment.
• Supports program compliance and assists in identifying opportunities to improve customer service and quality outcomes.
• Supports quality initiatives and activities, including adherence to Committee for Quality Assurance (NCQA) standards and HEDIS reporting.

Requirements:

• Requires BA/BS and a minimum of 5 years of experience in Health Care Management;
  • Or any combination of education and experience, which would provide an equivalent background.
• Current active unrestricted RN, PA, LSW, LCSW, LPC, LMHC, or other accepted license (as allowed by applicable state laws) and any other state or federal requirements that may apply are required.
• Managed care experience .
• Project management experience .
• Experience interpreting contracts, creating policies and procedures, and managing regulatory requirements is .