Health Manager Clinical Teams in Portland, ME

UP TO 10% BONUSThe Manager is responsible for the day-to-day operations of the clinical integrated teams comprised of complex care management, utilization and concurrent review and population health and disease management teammates. Assignments include compliance with all departmental, organizational, and accrediting policies, processes, and benefit guidelines. This position monitors appropriate utilization and administration of the case management programs and benefit plans to ensure consistency of decision making, quality of service and cost containment. Additionally, the manager has the responsibility of oversight for department operations and decision making in the absence of the Director. The Manager works closely with all members of the Medical Management Department as well as other Health Plan Operations and Support staff, including Claims, Member Services, Provider Inquiry, Informatics, Marketing, Product Development & Implementation and Managed Care Applications. The Manager will ensure that processes and staff comply with applicable regulatory and accrediting body standards (i.e. American Nurses Association (ANA), Case Management Society of America (CMSA) URAC, NCQA). Must be a licensed RN.