Manager, Case Management (Direct Hire)


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Overview

Company:
Professional Services Network Inc
Location:
Washington, District of Columbia
Department:
Nurse Opportunities
Category:
Direct Hire


Description

We have an immediate need for a Licensed Registered Nurse in the state of Maryland for the position of  Manager, Case Management. This position will be contingent upon award by the State and will require a contingency offer be signed showing intent to take the position once the contract has been awarded.

The position duties include, but are not limited to:

  • Manage department staff, policies, training, and budgets.
  • Utilize clinical review criteria guidelines/tools, such as InterQual for decision making.
  • Conduct precertification, preadmission, concurrent, retrospective, and appeal reviews.
  • Collaborate with management as the lead/liaison and subject matter expert of daily operations.
  • Ensure accreditation, contracts and legal requirements are met and maintained.
  • Must provide proof of Covid 19 vaccination.


Qualification

  • Bachelor’s degree required in related field; Master’s degree preferred
  • Knowledge of Medicaid and/or commercial insurance preferred
  • 5 years utilization/case management
  • 2 years management and financial management
  • Must be familiar with computers, software, and Microsoft suite
  • Ability to perform record reviews


Licensure

  • Active, unrestricted current RN license in the State of Maryland


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