Manager, Health Plan Contract Administration

Complexity of Work: Responsible for day-to-day oversight and coordination of case management and discharge planning functions ensuring patient care meets quality and efficiency standards while aligning with regulatory requirements. This role requires an understanding of payer guidelines and working closely with multi-disciplinary teams to optimize patient flow. Requires critical thinking and effective communication (verbal and written) skills, decisive judgment, and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action. Knowledge of State and Federal regulations governing discharge planning conditions of participation, hospital information systems (e.g., logician and IDX), staff development techniques, and performance improvements processes. Strong background in clinical decision making, medical criteria, and discharge planning. Must be proficient with Interqual or Milliman guidelines and use. Proficient in process improvement, and performance monitoring.
Required Work Experience: Minimum of three (3) years of case management experience and, at least, two (2) years of leadership experience within case management.
Other Information: Additional Education Info: Graduate of an accredited Registered/Professional Nursing program or a Bachelor's degree in Nursing (BSN).Additional Certification Info: Certification in Case Management preferred.
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