Case Management Director jobs in Rhode Island

Case Management Director oversees a staff of case managers responsible for patient care coordination. Develops and implements case management programs, including utilization review, intake or discharge planning, and managed care contracting or negotiation. Being a Case Management Director evaluates patient care data to ensure that care is provided in accordance with clinical guidelines and organizational standards. Seeks treatments that balance clinical and financial concerns with the family's needs and the patient's quality of life. Additionally, Case Management Director contributes to the development and improvement of clinical care pathways that enhance cost effectiveness while providing quality care. Typically requires a bachelor's degree. Typically reports to top management. May require Registered Nurse (RN). The Case Management Director typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. To be a Case Management Director typically requires 3+ years of managerial experience. (Copyright 2024 Salary.com)

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Manager Case Management
  • Blue Cross & Blue Shield of Rhode Island
  • Providence, RI FULL_TIME
  • Location: HybridCompensation: $90,500 - $135,700   Jump into the new world of health insurance: At Blue Cross & Blue Shield of Rhode Island (BCBSRI), our business is healthcare. But our focus is on improving lives. Be part of a team that is large enough to make a difference but small enough to be innovative. Work in a rapidly changing field. Take a chance to be creative. Move outside the status quo. Shape new ideas with the power of a national brand behind you.  Join others who know diversity is strength: We appreciate and celebrate everything that makes us unique: age, national origin, citizenship status, perspectives, experiences, physical or mental disability, military status, race, ethnicity, religion, gender, sexual orientation, gender identity and/or expression. Our diversity strengthens us as an organization and helps us better serve an increasingly diverse Rhode Island population.  Why this job matters: Responsible for managing daily operations and effectiveness of dual Medicare/Medicaid covered member care coordination.  Teams consists of nurse care managers, behavioral health care managers and social workers.  Provide optimized care management delivery for a program governed by a formal Model of Care (MOC).  Manager ensures clinically led engagement of the interdisciplinary care team by developing, documenting and communicating member centered care plans. Actively leverages data analytics, formal case audits and one on one coaching to drive performance.  Regularly delivers against industry standards, best practices, state/federal regulations, and corporate strategy. Partners with various internal and external stakeholders to drive continuous improvement with an innovative approach to both medical and behavioral health needs.   Collaborates with population health on new clinical pathways and engages team to incorporate innovative and focused approach to improved health outcomes.    What you will do: Manage case management programs to ensure the delivery of services are aligned with strategic goals. Support integration of behavioral health and medical management.   Collaborates with internal stakeholders including population health, data analytics, product and member services to drive member focused and compliant delivery supporting improved health outcomes.   Manages team of care managers, social workers and behavioral health care managers accountable for delivering on model of care commitments.   Optimize BCBSRI member care management delivery through collaboration with health care partners including, but not limited to accountable care organizations (ACOs), community-based organizations (CBOs), federally qualified health care centers (FQHCs), and community mental health centers (CMHCs).   Represents BCBSRI with external partners and supports presentation needs both internally and externally.   Collaborates on the develop of programs, interventions, and effectiveness measurements (evaluations) to support the achievement of departmental objectives and strategic priorities.   Ensure program compliance with all applicable regulatory guidelines including, but not limited to, NCQA, DOH, CMS, OHIC.   Monitor department expenses on a regular basis to ensure budget targets are achieved.   Provide direction and guidance to staff.  Set goals, review, and evaluate work, and prepare performance reviews.   Perform other duties as assigned.   What you need to succeed: Experience in medical and/or behavioral health field. Bachelor’s degree in nursing with an Unrestricted RN license, licensed psychologist (doctoral level), licensed independent clinical social worker (LICSW) or licensed mental health counselor (LMHC). Minimum of five to seven years’ experience in utilization review, case management, and/or disease management and up to five years clinical practice experience in medical/ behavioral health field or a combination of education and related work experience. Minimum of three to five years management experience or experience leading a team. Knowledge of managed benefits strategies, utilization review techniques, health care financing and delivery, program development, care management, quality management, and health care administration Knowledge of evidence based clinical practice. Ability to coach and motivate to maximize performance. Ability to effectively communicate goals and business objectives to employees. Strong and effective decision-making skills. Strong organization and time management skills. Proficiency with Microsoft Suite of products (i.e., Word, Excel, PPT, etc.) Ability to effectively interact with all levels of the organization. Ability to effectively delegate work and manage project tasks. Excellent verbal and written communication skills, with ability to convey complex or technical information in an effective manner. Extras Possession and maintenance of Case Management Certification (CCM) within three (3) years tenure in the position.  Experience in serving dually eligible populations and or those who experience food and housing insecurity as well as severe and persistent mental illness. Proven effectiveness in overseeing and influencing highly efficient and outcome driven teams.     Location: BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role: In-office: onsite 5 days per week Hybrid: onsite 2-4 days per week Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia
  • 4 Days Ago

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Case Management Nurse
  • The Judge Group
  • Providence, RI CONTRACTOR
  • Our client is currently seeking a Case Manager RN in Providence, Kent, or Washington RIShift- Mon to Fri 8-5pmContract: (4 Months)This job will have the following responsibilities:Ensure accurate and ...
  • 1 Day Ago

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Travel RN - Case Management
  • OneStaff Medical
  • Providence, RI PART_TIME
  • OneStaff Medical is seeking a travel nurse RN Case Management for a travel nursing job in Providence, Rhode Island.Job Description & RequirementsSpecialty: Case ManagementDiscipline: RNStart Date: ASA...
  • 10 Days Ago

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Pharmacy Director
  • Clinical Management Consultants
  • Woonsocket, RI FULL_TIME
  • Are you a dynamic Pharmacy Director ready to lead in a highly esteemed healthcare organization in Rhode Island?Embrace the opportunity to be an integral part of this state-of-the-art rehabilitation fa...
  • 7 Days Ago

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Pharmacy Director
  • Clinical Management Consultants
  • Smithfield, RI FULL_TIME
  • Are you a dynamic Pharmacy Director ready to lead in a highly esteemed healthcare organization in Rhode Island? Embrace the opportunity to be an integral part of this state-of-the-art rehabilitation f...
  • 7 Days Ago

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Director of MDS
  • GreenTree Healthcare Management
  • Bristol, RI FULL_TIME
  • SIGN ON BONUS $7,500! We offer competitive salary, full benefits package, Paid Time Off, and opportunities for professional growth. Silver Creek Manor is looking to hire a full-time Director of MDS. W...
  • 1 Month Ago

Rhode Island (/ˌroʊd -/ (listen)), officially the State of Rhode Island and Providence Plantations, is a state in the New England region of the United States. It is the smallest state in area, the seventh least populous, the second most densely populated, and it has the longest official name of any state. Rhode Island is bordered by Connecticut to the west, Massachusetts to the north and east, and the Atlantic Ocean to the south via Rhode Island Sound and Block Island Sound. It also shares a small maritime border with New York. Providence is the state capital and most populous city in Rhode Is...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Case Management Director jobs
$158,088 to $222,001

Case Management Director in Greenville, SC
Reporting to the Regional Vice President of Case Management, the Executive Director of Case Management will oversee case management services over three or more hospitals as well as collaborating with the VP to implement system-wide initiatives.
January 15, 2020
Case Management Director in Las Vegas, NV
Are there special trainings or certifications recommended or required for case managers? Most hospitals don’t require their case managers to have master’s degrees, but many facilities prefer them to earn the designation of CCM (certified case manager).
December 06, 2019
Case Management Director in Macon, GA
With the aging population and more people aging in place at home, how has the role of the case manager changed? With changes in the aging population and the insurance plans that cover them, we’re really like a task force that finds ways to connect patients with the resources they need to prevent illness and hospitalization.
December 16, 2019