Manager, RN/SW Clinical Ops (Case Management) - Remote | WFH - Get It Recruit - Healthcare
Lake Como, NJ 07719
About the Job
Job Summary:
We are seeking a dedicated leader to oversee both clinical and non-clinical operations. In this role, you will assist the Director in establishing, interpreting, and implementing new and existing policies and procedures. Your responsibilities include ensuring compliance with regulatory agency requirements and analyzing utilization, performance trends, and healthcare quality to ensure timely and cost-effective delivery.
Responsibilities:
Oversee and coordinate daily activities to meet departmental goals related to timeliness, accuracy, and consistency in medical decisions.
Manage and direct staff to ensure client satisfaction, service delivery quality, and positive outcomes.
Identify opportunities to improve care/services quality and implement steps to enhance outcomes.
Act as a subject matter expert for various projects and regulatory committees.
Develop and implement policies, procedures, and reports to meet regulatory guidelines.
Maintain and monitor the departmental budget to manage administrative costs.
Lead audits and ensure compliance with regulatory standards.
Identify and implement business process improvements for efficiency and cost savings.
Collaborate with other teams to ensure consistent policy application and facilitate inter-department projects.
Represent the department in external customer and regulatory affairs.
Champion an open communication environment, fostering employee engagement, teamwork, and continuous improvement.
Manage departmental budget and ongoing expense management.
Provide feedback, coaching, and performance reviews for staff, ensuring compliance with regulatory requirements and internal policies.
Education/Experience:
Nursing degree or a Bachelor's in a health-related field required.
Minimum of five (5) years' experience in a healthcare-related field.
At least five (5) years of broad clinical experience.
Minimum of three (3) years of direct supervisory experience or leading teams in a matrix management environment.
Professional certification in a clinical specialty preferred.
Additional Licensing, Certifications, Registrations:
Active Unrestricted NJ LCSW, LMFT, LPC, or RN License Required.
Knowledge:
Strong knowledge of departmental functional tasks.
Principles of risk management and quality assurance.
NCQA standards and state mandates and regulations.
Processes of regulatory bodies.
Plan products, applications, policies, procedures, and systems preferred.
Skills and Abilities:
Excellent organizational skills and ability to set priorities.
Strong oral and written communication skills.
Effective presentation skills.
Comprehensive leadership and decision-making skills.
Strong analytical, problem-solving, and critical analysis skills.
Proficiency in personal computers and software in a Windows-based environment, including MS Office products (Word, Excel, PowerPoint) and Outlook.
Travel:
Travel required to various office locations, provider sites, and for oversight of remote workforce members as needed.
Salary Range:
$106,400 - $145,215
Compensation is based on factors including education, experience, licensure, certifications, geographic location, and internal equity. A comprehensive benefits package is also provided, including health benefits, retirement plans, PTO, incentive plans, wellness programs, paid volunteer time off, and tuition reimbursement.
We are an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status, or disability status. Reasonable accommodation requests will be considered as part of the recruiting and hiring process.
Employment Type: Full-Time
Salary: $ 106,400.00 145,215.00 Per Year
We are seeking a dedicated leader to oversee both clinical and non-clinical operations. In this role, you will assist the Director in establishing, interpreting, and implementing new and existing policies and procedures. Your responsibilities include ensuring compliance with regulatory agency requirements and analyzing utilization, performance trends, and healthcare quality to ensure timely and cost-effective delivery.
Responsibilities:
Oversee and coordinate daily activities to meet departmental goals related to timeliness, accuracy, and consistency in medical decisions.
Manage and direct staff to ensure client satisfaction, service delivery quality, and positive outcomes.
Identify opportunities to improve care/services quality and implement steps to enhance outcomes.
Act as a subject matter expert for various projects and regulatory committees.
Develop and implement policies, procedures, and reports to meet regulatory guidelines.
Maintain and monitor the departmental budget to manage administrative costs.
Lead audits and ensure compliance with regulatory standards.
Identify and implement business process improvements for efficiency and cost savings.
Collaborate with other teams to ensure consistent policy application and facilitate inter-department projects.
Represent the department in external customer and regulatory affairs.
Champion an open communication environment, fostering employee engagement, teamwork, and continuous improvement.
Manage departmental budget and ongoing expense management.
Provide feedback, coaching, and performance reviews for staff, ensuring compliance with regulatory requirements and internal policies.
Education/Experience:
Nursing degree or a Bachelor's in a health-related field required.
Minimum of five (5) years' experience in a healthcare-related field.
At least five (5) years of broad clinical experience.
Minimum of three (3) years of direct supervisory experience or leading teams in a matrix management environment.
Professional certification in a clinical specialty preferred.
Additional Licensing, Certifications, Registrations:
Active Unrestricted NJ LCSW, LMFT, LPC, or RN License Required.
Knowledge:
Strong knowledge of departmental functional tasks.
Principles of risk management and quality assurance.
NCQA standards and state mandates and regulations.
Processes of regulatory bodies.
Plan products, applications, policies, procedures, and systems preferred.
Skills and Abilities:
Excellent organizational skills and ability to set priorities.
Strong oral and written communication skills.
Effective presentation skills.
Comprehensive leadership and decision-making skills.
Strong analytical, problem-solving, and critical analysis skills.
Proficiency in personal computers and software in a Windows-based environment, including MS Office products (Word, Excel, PowerPoint) and Outlook.
Travel:
Travel required to various office locations, provider sites, and for oversight of remote workforce members as needed.
Salary Range:
$106,400 - $145,215
Compensation is based on factors including education, experience, licensure, certifications, geographic location, and internal equity. A comprehensive benefits package is also provided, including health benefits, retirement plans, PTO, incentive plans, wellness programs, paid volunteer time off, and tuition reimbursement.
We are an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status, or disability status. Reasonable accommodation requests will be considered as part of the recruiting and hiring process.
Employment Type: Full-Time
Salary: $ 106,400.00 145,215.00 Per Year
Source : Get It Recruit - Healthcare