Case Management Manager Regional

📁
Claims
📅
70321 Requisition #

Gallagher Bassett is the premier provider of global claims services, dedicated to exceptional customer service and demonstrably superior outcomes. GB helps people, teams and businesses overcome adversity and loss through the guiding expertise of over 5,000 claims professionals, all committed to going beyond expectations in the continuous pursuit of a better way.

Job Description:

  • Manages and coordinates regulatory compliance issues of case management department and provides support and oversight of department operations/processes.
  • Manages case management field staff, across several territories.
  • Develops and maintains individual state regulatory compliance to include preparing state applications, renewals, quarterly, and annual reports.
  • Maintains current and new licensure or certification requirements as mandated by state regulations, i.e. managed care organization (MCO), utilization review (UR), etc. Assists in maintenance of national accreditation.
  • Complies with requested reports and audits from state regulatory entities.
  • Revises and develops policies and procedures, as appropriate. Assists in annual review of departmental policies and procedures.
  • Communicates current and new regulations to all departments.
  • Interfaces with continual quality improvement programs, as appropriate.
  • Provides department services as outlined and maintains a case load equivalent to one-half full time nurse reviewer.
  • Oversees and manages staff and develops, implements, and maintains criteria for the review process.
  • Manages process and ensures efficiency, timeliness, and accuracy.
  • Manages and monitors work distribution and workflow of staff.
  • Reviews and monitors daily management reports for branch and system functions.
  • Develops regional staffing and maintains training programs.
  • Provides staff cross-training for continued operation efficiency.
  • Prepares agendas and conducts staff meetings.
  • Communicates effectively with medical providers, peer advisors, adjusting staff, government agencies, customers, staff, and peers.
  • Interviews and hires case management staff.
  • Develops and manages staff to meet or exceed goals established.
  • Monitors and/or maintains documentation resource for verbal/written requests, inquiries, and complaints.
  • Attends training/educational classes as appropriate. Participates in quality assurance auditing.
  • Develops and manages staff to meet or exceed goals established.

Requirements

  • Must possess current nurse licensure/registration.
  • Must possess minimum of five years recent clinical experience.
  • Nursing experience must include experience with orthopedic, trauma, intensive care, or occupational nursing.
  • Must possess minimum of three years experience as a supervisor or team leader.

Desired:

  • Prefer Worker's Compensation experience.

Work Traits:

  • Must possess demonstrated knowledge of ICD-9 codes, utilization review process, use of criteria, and computer skills.
  • Must possess good written and oral communication, organizational, and leadership skills.
  • Must be proficient in decision making, problem solving, and time management.

U.S. Eligibility Requirements:

  • Interested candidates must submit an application and resume/CV online to be considered
  • Must be 18 years of age or older
  • Must be willing to submit to a background investigation; any offer of employment is conditioned upon the successful completion of a background investigation
  • Must have unrestricted work authorization to work in the United States.  For U.S. employment opportunities, Gallagher hires U.S. citizens, permanent residents, asylees, refugees, and temporary residents. Temporary residence does not include those with non-immigrant work authorization (F, J, H or L visas), such as students in practical training status. Exceptions to these requirements will be determined based on shortage of qualified candidates with a particular skill. Gallagher will require proof of work authorization
  • Must be willing to execute Gallagher's Employee Agreement or Confidentiality and Non-Disclosure Agreement, which require, among other things, post-employment obligations relating to non-solicitation, confidentiality and non-disclosure

Gallagher offers competitive salaries and benefits, including: medical/dental/vision plans, life and accident insurance, 401(K), employee stock purchase plan, educational expense reimbursement, employee assistance program, flexible work hours (availability varies by office and job function) training programs, matching gift program, and more.  

 

Gallagher believes that all persons are entitled to equal employment opportunity and does not discriminate against nor favor any applicant because of race, sex, color, disability, national origin, religion, creed, age, marital status, citizenship, veteran status, gender, gender identity / expression, actual or perceived sexual orientation, or any other protected characteristic.‚Äč Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified applicant with a disability, unless the accommodation would impose an undue hardship on the operation of our business.

 

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