Manager of Utilization and Case Management
Mercyhealth, a non-profit health care organization serving Wisconsin and Illinois, is seeking a Manager of Utilization and Case Management to join our MercyCare team at our Janesville trauma center.
In this role, you’ll use your clinical nursing and managed care and/or health management experience to coordinate our MercyCare team to meet operational needs, ensure compliance with contractual, state and federal health plan requirements, adhere to Medicare and Medicaid guidelines and NCQA standards, and manage assigned operations for utilization management and case management services.
The position also requires the ability to foster communication and teamwork in the department and between physicians, marketing, customer service, claims, quality, corporate departments, vendors and senior leadership. The manager will assist senior leadership with long-term planning initiatives to maintain operations as well as the mission and values of the company.
As a leader of our MercyCare team, this position will receive competitive compensation and benefits, tuition and certification reimbursement, generous PTO accruals, and a rewarding work-life balance. We also provide all partners with professional development pathways, community and charity opportunities, partner recognition days, and more.
Qualified candidates must possess:
- Bachelor of Science in Nursing
- 5 + years of varied clinical experience
- 5+ years of experience in the managed care, disease/utilization management, case management with a minimum of three years at the management level or above
- 2+ years of experience with Epic/ Tapestry Referral program.
- Broad Knowledge of federal and state laws relating to health care and insurance companies in MercyCare service areas.
- Valid RN license in Wisconsin and/or Illinois