<p>Registered Nurse Manager, Case Management Operations</p> <p>As the RN Manager, Case Management Operations you will foster a culture of collaboration, adaptability, and accountability by guiding day-to-day operations, championing process improvements, and ensuring team members are equipped to succeed through training, feedback, and professional growth opportunities. You will lead a team of remote, telephonic complex care RN case managers to best deliver high quality service to Tricare beneficiaries.</p> <p>Work schedule Monday - Friday 5 days x 8 hours</p> <p>Rotating shift times with 2 or 3 days per week starting at 8 am and 11 am.</p> <p>Responsibilities:</p> <ul> <li>Monitors daily activities of team and serves as a resource to staff as needed to answer or clarify questions, issues, or concerns. </li><li>Assist with coordination and facilitation of regular staff 1:1 meetings, remote team meetings, department meetings, and case rounds with the medical directors. </li><li>Provide direct, confidential coaching and feedback to individual staff regarding quality audit results, along with suggestions for improvement in individual performance as appropriate. </li><li>Provide interview and hiring assistance as directed by the AVP. Collaborates with the Training leaders for new hire orientation and supports the ongoing learning needs of the team. </li><li>Provide ongoing training, mentoring, guidance, coaching, and disciplinary action as directed. </li><li>Conduct corrective action and counseling with staff, as directed by the AVP. Document interventions with staff and communicates outcomes to AVP. </li><li>Document staff performance and assist AVP with conducting performance evaluations. </li><li>Maintain a working knowledge of beneficiary benefits, contracts, case management policies, professional standards of practice, and community resources to ensure that optimum outcomes are achieved. </li><li>Understands the scope of professional licensure and assists team to conduct case management activities consistent with the scope of this licensure. </li><li>Assist teams in recognizing potential or actual risk management issues and follows through with reporting per process. Appropriately escalate issues as needed. </li><li>Identify process-oriented opportunities for improvement to promote effective and efficient case management services. </li><li>Investigative internal research for grievance and complaints and supports resolution as directed by AVP. </li><li>Collaborates and coordinates the activities of the assigned case management staff to ensure adequate staffing, workloads, and time off. </li><li>Assess daily staffing levels needed and regularly communicate operational status of business. Evaluates caseloads for applicable staffing based on eligibility criteria, needs of members, and staff qualifications. Provides recommendations to AVP for staffing levels. </li><li>Participate in projects, committees, meetings, employee engagement initiatives and other activities as directed by the business leadership. </li><li>Maintain CEUs as required by applicable State Board(s) of Nursing and required certifications. Must be willing to obtain and maintain additional licenses as required to meet business needs. </li><li>Effectively collaborate with other managers to facilitate program delivery. </li></ul> <p>Qualifications:</p> <p>Required</p> <ul> <li>Must hold United States citizenship status. </li><li>Ability to obtain Security Clearance required. Current DOD Security Clearance preferred. </li><li>Current, unrestricted RN license in state of residence with multi-state privileges (an active compact state license) </li><li>2+ years of direct experience managing a clinical team. </li><li>5+ years of RN experience in a clinical role with responsibilities for direct patient care. </li><li>Bachelor's degree in nursing from an accredited college, university, or school of nursing required. </li><li>Experience as an RN in case management operations. </li><li>Experience managing RN teams in a remote environment. </li><li>Proficient in Microsoft Office product suite (Word, Excel, PowerPoint, Outlook, Teams) and mobile technologies (laptop, smartphone apps, etc.). </li></ul> <p>Preferred</p> <ul> <li>Case Management Certification (CCM preferred). </li><li>Experience as a telephonic RN case manager managing health plan members. </li><li>Experience participating in performance improvement or quality improvement projects. </li><li>Experience working in an NCQA-accredited Case Management program. </li><li>Ability to navigate multiple simultaneous work demands remotely in an effective and professional manner. </li><li>Ability to resolve issues independently and demonstrate ability to multi-task. </li><li>Executive presence, effective communication skills (verbal, written, presentation, interpersonal). </li><li>Commitment to building team skills and fostering a positive work environment. </li><li>Knowledge of payor issues, including Trihealth benefits and contract limitations, provider network issues, and case management initiatives. </li></ul> <p>What We Offer:</p> <ul> <li>EXL Health offers an exciting, fast paced, and innovative environment, which brings together a group of sharp and entrepreneurial professionals who are eager to influence business decisions. </li><li>From your very first day, you get an opportunity to work closely with highly experienced, world-class Healthcare consultants. </li><li>You can expect to learn about many aspects of businesses that our clients engage in. You will also learn effective teamwork and time management skills - key aspects for personal and professional growth. </li><li>We provide guidance/ coaching to every employee through our mentoring program wherein every junior level employee is assigned a senior level professional as advisors. </li><li>Sky is the limit for our team members. The unique experiences gathered at EXL Health sets the stage for further growth and development in our company and beyond. </li></ul>