Responsibilities
- Provides leadership and direction to Case Managers, Supervisors and their designated teams, ensuring day-to-day operations align with company and customer guidelines and expectations.
- Oversees the assignment of referrals, ensuring timely and accurate time and notes entry into the case management database, and maintaining adherence to all Opus Medical guidelines and customer requirements.
- Drives and manages the overall case management workflow, including reviewing documentation for accuracy, quality, and compliance.
- Conducts regular review of departmental reports, invoices, logs, and expense data on a daily, weekly, and monthly basis to monitor performance and identify areas for improvement.
- Upholds and enforces compliance with all company policies and legal requirements regarding personal health information (PHI and IIHI).
- Ensures quality of service delivery across the department and oversees the resolution of client complaints and escalations.
- Manages human resources matters within the department, including performance management, coaching and development of supervisors, and partnering with HR on employee relations issues.
- Fosters a culture of accountability, collaboration, and continuous improvement across the case management team.
- As a licensed RN, provides clinical oversight and direction for case management clinical activities, ensuring nurses are practicing within scope and in accordance with nationally recognized standards of care.
- Serves as the clinical authority for the department and may provide guidance and direction to supervisors and case managers on complex referrals.
- Participates in marketing and client support activities, attends client meetings, and represents the case management department in organizational and external initiatives.
- Travel may be required.
Requirements
- Active Registered Nurse (RN) license in good standing
- Bachelor of Science in Nursing (BSN)
- Minimum of 5-7 years of clinical nursing experience
- Minimum of 3-5 years in case management
- Strong working knowledge of case management principles, workers’ compensation, and/or managed care options
- Ability to lead, develop, and motivate a high-performing team in a fast-paced, remote environment
- Strong analytical skills with the ability to interpret operational reports and drive informed decisions
- Excellent verbal and written communication skills
- Ability to effectively manage relationships and resolve escalations professionally
- Proficiency in case management platforms and Microsoft
- Thorough understanding of HIPAA and all applicable regulations governing personal health information (PHI and IIHI)
Nice to Have
- Master’s degree in Nursing, Healthcare Administration, or a related field
- Nationally recognized case management certification such as a CCM, ACM, or equivalent
- Supervisory or leadership experience
- Additional certifications in workers' compensation, disability management, or utilization review
Additional Information
- Travel may be required.
- Remote with occasional travel as required for customer visits, team offsites, or industry events.
