Rn Manager Medical Management
Amerigroup (Norfolk/Hampton Roads, Virginia)

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Registered Nurse Manager for our National Call Center

JOB SUMMARY:
The Manager of Medical Management Services is responsible for day to day operations of the Medical Management Department at the National Contact Center (NCC). The nurse manager is responsible for providing clinical, management and leadership expertise in the oversight of the associates and supervisors that are performing preauthorization services and nurse help line activities. The Manager is involved in planning, implementing and evaluating current processes including operational statistics and service standards. Provides oversight in the planning, implementation and coordination of necessary health care services for Amerigroup members to ensure high quality, cost effective care.

PRIMARY RESPONSIBILITIES:     
Direct, daily supervision of department, including nurses and pre-authorization assistants.
Is responsible daily for the performance of department to meet corporate service levels.
Ensures that department is adequately staffed at all times. Alters daily assignments as needed to ensure coverage is adequate. Identifies need for additional staffing based on performance.
Manages departmental projects as assigned, including staff assignments, and reporting.
Reviews monthly incentive results and validates accuracy, meeting all associated timelines.
Assists with ensuring departmental spending is within budget as applicable.
for working with the Call Coaches to insure optimal levels of performance. Elevates calls for dispute resolution.
Assists director in developing medical management policy, procedure and guidelines.
Completes performance appraisals meeting all associated timelines. Reviews departmental appraisals and ensures consistent application of scoring guidelines. Creates development plan for associates and assists with setting departmental standards.
Provides education to providers concerning Amerigroup policies to improve quality and appropriateness of care.
Maintain adequate reporting to assure compliance with all departmental standards and policies. Performs required data entry into the NCC database.

EDUCATION AND EXPERIENCE:
•RN required
Preferred:
•BSN preferred
•Case management or utilization review experience
Required:
•3-5 years clinical experience
•Previous management/supervisory experience or 1-2 years experience within the clinical area at Amerigroup having demonstrated leadership ability within project management or other equivalent assignment.
Preferred:
•1-2 two years of utilization review/case management experience
Specific Technical Skills
Required:
Excellent verbal and written communication skills.
•Maturity, self-confidence and a good grasp of managed care concepts.
•Self-starter with the ability to handle multiple projects at one time.
•Multi task-oriented, ability to follow-up on numerous complex problems.
•Strong decision-making skills.
•Excellent management skills.
•Ability to prioritize.
•Computer literate (word processing, spreadsheet and database applications).
•Ability to occasionally work all shifts.
•Able to travel.
•High energy level.
•Appreciation of cultural diversity and sensitivity towards target population.

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