Clinical Case Manager
6 days ago
Overview
We are seeking a skilled Clinical Case Manager to join our team at AmTrust Financial Services, Inc. in the United States.
The salary for this position is $85,000 - $115,000 per year, depending on experience and location.
Job Description
This role will provide comprehensive oversight activities aligned with our organization's quality and medical case management standards. As a Clinical Case Manager, you will report to the Director of Medical Education and Strategy within our Managed Care Organization.
You will focus on developing and executing Quality Assurance Programs for internal and external managed care clinical programs to align with our holistic approach to achieving best-in-class outcomes for claims.
Responsibilities include reviewing utilization review programs, pharmacy program clinical oversight, home health, and all care coordination for claims, as well as identifying and analyzing trends to provide recommendations for program improvement.
- Carry out quality assurance oversight activities defined in AmTrust's Medical Case Management and Quality Assurance Standards.
- Conduct regular and systematic reviews of managed care internal and external medical case management files to validate comprehensive case assessments and evaluations.
- Review managed care programs, including utilization review, pharmacy, home health services, diagnostic, physical medicine, and independent medical evaluations.
- Analyze quality assurance reporting metrics to identify strengths and trending, and provide recommendations for educational training development needs.
- Measure and identify staffing competency levels from quality assurance reviews.
- Track, monitor, and measure quarterly and annual performance of programs.
- Present reports, findings, and recommendations for enhancements and/or changes based on analysis to managed care leadership and workers' compensation leadership teams.
- Work with managed care leadership and nurses to calibrate quality standards across all offices.
Qualifications
To be successful in this role, you must have:
- Active unrestricted RN license in a state or territory of the United States.
- Bachelor's degree in nursing (BSN) from an accredited college or university or equivalent work experience.
- Certification in case management, rehabilitation nursing, or a related specialty.
- Quality Assurance program designations such as Health Care Quality and Management certification (HCQM) highly preferred.
Benefits
We offer a competitive compensation package and excellent career advancement opportunities. Our benefits include:
- Medical & Dental Plans.
- Life Insurance, including eligible spouses & children.
- Health Care Flexible Spending.
- Dependent Care.
- 401k Savings Plans.
- Paid Time Off.
We value excellence and recognize that by embracing diverse backgrounds, skills, and perspectives of our workforce, we sustain a competitive advantage and remain an employer of choice.
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