Supervisor, Case Management

Imagine360; United States; Remote; USD 90,000 - 120,000; Full time

Benefits offered by this job

Health plan options

Company paid premiums for disability &

Life insurance

PTO 20 days to start

10 paid holidays

Tuition reimbursement

401k company contribution

Professional development opportunities

Diversity and inclusion initiatives

Job summary

Imagine360, based in the United States, seeks a Supervisor, Case Management to lead a remote team of Case Managers within group health plans.

You will supervise clinical operations, ensure HIPAA/URAC/ERISA compliance, review billing, and support quality initiatives through coaching and training. RN licensure is required; CCM is preferred or to be pursued within 12–24 months.

Qualifications

• Nursing degree from an accredited college or university.
• RN licensure in good standing; CCM preferred or willing to obtain within 12–24 months.
• 3 years of clinical experience with direct patient care responsibilities.
• Experience mentoring or managing a team of staff.
• URAC accredited Case Management experience preferred.
• Experience in insurance or TPA with self-funded plans is a plus.

Responsibilities

• Provide supervision and education to Case Managers on case management topics.
• Review monthly billing and monitor utilization and medical necessity.
• Lead quality program initiatives, data reporting, and training.
• Oversee caseloads, schedules, and PTO to meet business needs.
• Mentor, coach, and develop staff; lead process improvement projects.
• Ensure HIPAA/PHI compliance in all activities and communications.

Skills

Nursing

Leadership

Communication

Problem solving

Multitasking

HIPAA compliance

Education

Nursing degree

Bachelor's degree in nursing

Tools

Microsoft Outlook

Microsoft Word

Microsoft Excel

PowerPoint

Job description

Imagine360 is seeking a Supervisor, Case Management to join the team! The Supervisor, Case Management is responsible for providing supervision to Case Managers and case management services under the group health plans by utilizing their nursing education, supervisory, clinical, and professional experiences.

Position Location

100% remote

Responsibilities include but are not limited to

• Collaborate with Manager, Case Management to:
  • Edit, maintain, and implement Policies & Procedures that meet applicable accreditations and business needs.
  • Provide oversight and education to the Case Managers on topics related to case management and review of medical necessity.
  • Review and audit monthly billing for the Case Managers.
  • Complete duties to support Quality Program initiatives including collection of data, reporting and training of employees to meet quality program initiatives.
  • Maintain and report results of satisfaction surveys.
  • Research member complaints and provide resolution.
  • Participate in interview processes and onboarding of new employees.
  • Establish orientation schedule, coordinate, and participate in new employee training as directed.
  • Oversee and evaluate caseloads for applicable employees based on eligibility criteria, needs of member, and employee qualifications.
  • Monitor employee schedules and PTO coverage to meet business needs.
  • Responsible for day-to-day management and performance of a team, provide mentoring and coaching as needed.
  • Lead projects that promote improvement in delivery of services.
  • Complete & report quality assurance reviews, call and chart audits of Case Managers.
• Lead, attend, and participate in 1:1s, team meetings, trainings, and other job specific events as required.
• Communicates (in compliance with HIPAA) with brokers, vendors, Relationship Managers, HR representatives and stop loss as needed.
• Communicates professionally and effectively.
• Staff complex cases with Manager, Case Management or Senior Manager, Patient Care Services.
• Adhere to established internal regulations regarding Department of Labor, HIPAA, ERISA and department and company policies and Procedures.
• Complete HIPAA Training Annually.
• Perform all tasks in accordance with HIPAA/PHI guidelines.
• Appropriately escalation difficult issues.
• Complete duties in accordance with scope of licensure and certifications held or requested.
• Perform other duties and projects, as assigned.

Required Experience/Education

• Nursing degree from an accredited college, university, or school of nursing.
• Bachelor's degree in nursing preferred but not required.
• 3 years' experience in a clinical role with responsibilities for direct patient care.
• Experience in Utilization Management, Case Management, or transferable clinical experience and skills.
• Experience mentoring or managing a team of clinical or non-clinical staff.
• Experience working in an URAC accredited Case Management program preferred.
• Experience working within an insurance agency or TPA experience specializing in employee benefits and self-funded medical plans.

Skills and Abilities

• Ability to work independently in a home office environment.
• Computer skills which include proficiency in Microsoft Outlook, Word, Excel, and PowerPoint, as well as navigation utilizing the internet.
• Ability to resolve problems independently and demonstrate ability to multi-task.
• Strong written, oral, and telephonic communication skills.
• Strong presentation skills.
• Ability to demonstrate a commitment to building new skills and fostering a positive work environment.
• Demonstrated organizational skills, problem-solving, analytical skills, and detail oriented.
• Demonstrated ability to prioritize workloads, multi-task, and manage priorities to meet deadlines.
• Ability to maintain the confidentiality of protected health information in compliance with HIPAA regulations.

License and Certifications

• An active and unrestricted Registered Nurse License in eNLC compact state. Must maintain CEUs as required by applicable State Board(s) of Nursing and required certifications. Must be willing to obtain and maintain additional license as required to perform the job functions of the organization.
• Certified Case Manager (CCM) designation preferred if candidate does not have will require and support obtaining within 12- 24 months of hire.

What can Imagine360 offer you?

• Multiple Health plan options
• Company paid employee premiums for disability and life insurance
• Parental Leave Policy
• 20 days PTO to start / 10 Paid Holidays
• Tuition reimbursement
• 401k Company contribution
• Company paid Short & Long term Disability plus Life Insurance
• Professional development initiatives / continuous learning opportunities
• Opportunities to participate in and support the company's diversity and inclusion initiatives

Imagine360 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise. Over the years, we've helped thousands of employers save billions on healthcare. Our breakthrough total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions.