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LISTING: Dir. of Managed Care RN, Workers Comp – Princeton, NJ

Our client, a fast-growing commercial insurance company, is seeking a RN Branch Manager of Telephonic Case Management for Workers Compensation. Your clinical talent and leadership abilities will contribute to their competitive edge.  The Director of Managed Care will have responsibility for managing the performance, productivity, and medical management outcomes of managed care operations. This role will have oversight of telephonic nurse case management, pharmacy management nurses and UR nurses to deliver optimal claim results. Multiple Branch Managers and offices reporting to this position.  (Branch Manager in this location is also open)

 

Responsibilities: 

  • Execute medical management strategy; analyze medical management results and create annual operational goals and objectives for claim handling operation.
  • Serve as a technical and business resource for nurse case management
  • Monitor and analyze significant legal developments and legislative changes that may affect medical management. Collaborate with the Director of Medical Strategy and Clinical Optimization to address changes.
  • Participate in the effective selection, coaching, medical education, and clinical development of nurse case managers.
  • Manages project development/enhancements through coordination with WC operations
  • Ensure regulatory compliance with jurisdictional workers’ compensation rules and statutes.
  • Knowledge of workers’ compensation laws and regulations 
  • Experience applying medical management treatment guidelines
  • Experience with State and external accreditation managed care audits and reviews

 

Requirements:

  • Active unrestricted RN license/compact license. BSN from accredited college or university or equivalent work experience preferred. Certification in case management, pharmacy, rehabilitation nursing or a related specialty is highly preferred. 
  • Seven (7) years of related experience or equivalent combination of education and experience required to include two (2) years of direct clinical care OR two (2) years of case management/utilization management required. 
  • Five to seven years of direct nurse management experience.

 

What Our Client Offers: 

Our client offers a great work environment, competitive compensation package and excellent career advancement opportunities. Their benefits include: Medical and Dental Plans, Life Insurance, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, and Paid Time Off.   

 

If you or anyone you know of is interested in this position, please email all resumes to us for immediate consideration.

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(This job listing is assigned to be sent to: Ross.)

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