RN - Manager for Case Management & Behavioral Health Coordinated Care (BHCC)

First Choice Health, located in downtown Seattle, is a Seattle-based, physician and hospital owned company that has served Washington and the Northwest since 1985. We now serve well over one million people with our array of products and services. First Choice Health Preferred Provider Organization (PPO) is recognized as the leading independent PPO in Washington State and has a growing regional presence in Idaho, Montana and Alaska. Our network includes more than 27,000 directly contracted and credentialed providers and is used by a wide variety of insurance companies, third party administrators, and plan sponsors. We are seeking a Manager for Case Management & Behavioral Health Coordinated Care (BHCC) in our Medical Management Department.  POSITION SUMMARY:

The Manager for Case Management (CM) and Behavioral Health Coordinated Care (BHCC) provides leadership and oversight for the CM and BHCC programs. Provides direct supervision to Case Managers, Behavioral Health Coordinators, and CM Support Specialist. Develops and maintains strong working relationships with payers, brokers, and internal departments for POP/TPA services. Develop and/or implements policies and procedures for CM and BHCC and coordinates UM activities with other managers. Supports quality management and accreditation activities; complies with HIPAA and ERISA standards

 EXAMPLES OF DUTIES:

1. Directs Case Management program and supervises case managers and non-clinical case management support staff and assures that all regulatory accreditation and FCH Policies requirements are met.

2. Develops revenue budget for Case Management and assist with projections for departmental budget.

3. Coordinates and collaborates with Utilization Management Managers regarding PPO/TPA UM daily activities.

4. Collaborates with VP of Medical Management to maintain staffing levels according to enrollment and designated departmental functions.

5. Reviews and revises case management policy and procedures, program description and quality plan annually and presents to the Medical Advisory Committee.

6. Participates in Medical Advisory Committee; reporting quality measures; participates in action planning. Works with the VP of Medical Management to ensure compliance of departmental standards.

7. Interview and hires new staff accordingly. Ensures new employees are oriented and obtain the job training necessary to their position. Assures compliance with annual training.

8. Accountable for the reporting of Case Management activities to payors.

9. Maintains open communication with internal and external customers, especially payers and consultant/brokers.

10. Develops a positive working relationship with Marketing and PPO network departments to enhance the implementation of new Groups.

11. Other duties as assigned.QUALIFICATIONS:

1. Current WA State RN License and obtains licensure in OR, ID, and AK within one year of hire. 

2. CCM or other comparable certification.

3. BS degree in related field or equivalent work experience.

4. Strong written and verbal skills.

5. Strong organizational and time management skills.

6. Proficient computer skills.

7. Minimum five years experience in an HMO/healthcare industry.

8. Minimum three years management experience.

9. Solid knowledge of case management and utilization management. PHYSICAL REQUIREMENTS:

1. Ability to see and hear within normal ranges with or without aid.

2. Ability to bend, and move within normal ranges.

3. Ability to be stationary for long periods of time.

4. Finger and hand dexterity.

5. Able to lift a minimum of 10-20 pounds. ACCESS TO PHI:Routine & re-occurring access to all forms of PHI ? The duties of the position require regular and unrestricted contact with PHI. 

How to Apply:

 

We offer competitive salary and benefits, including medical, dental, vision, and 401(k), as well as a transportation subsidy, plus a business casual work environment. Qualified candidates may submit a cover letter and resume to our website at www.fchn.com or hrweb@fchn.com .  We are offering a $4,000.00 sign on bonus or towards relocation.