QuestPro Consultants is partnering with a leading national managed care corporation to select a key operational leader for their National Catastrophic Program. This candidate can be located anywhere in the USA, however prefer them to be domiciled in or near Philadelphia, PA.

The role would consist of overseeing a staff of dedicated employees to effectively process / staff catastrophic case referrals.    The position requires a good deal of intra-company communications, sense of urgency in response to time sensitive follow up.    Construction of management reports and client facing presentation skills are necessary.   Some travel is expected, but only 10-15% on average.   

Responsibilities

• Monitoring Catastrophic Case Management Ovsight activity to ensure the services delivered are in keeping with Corporate's quality standards, and that reports.
•  Lead recruiting efforts of qualified professional staff accordingly and within established personnel guidelines. 
• Evaluate staffing of cases based on case specifications.  Assessing billing reports and conducting case reviews for progress, quality, and accuracy.
• Lead Supervisors' of Catastrophic Case Managers; providing 1:1 direction and guidance for Catastrophic files.
• Providing technical oversight for programs to support to case managers by fully understanding workers’ compensation regulations and the current legal issues pertaining to our industry. 
• Providing technical support to marketing by accompanying them on customer calls. 
• Participating in National and Branch staff meetings to relay company specific information, as necessary.  Providing employees with an open door approach to identify and reduce barriers, with the goal of providing solutions for case management success.
• Collaborate with Supervisors for orienting new Catastrophic Case Managers on program procedures and other Corporate specifics of operation.
• Providing nation-wide support to ensure uninterrupted work flow within the branches throughout the company.

Qualifications

• B.S., B.A., R.N. or B.S.N. required. Masters and/or advanced study in a health-related field desired.
• At least 3-5 Management oversight over nurses preferably with in WC CAT.
• Prior experience in related field (nursing, counseling, etc.) required.
• Prior supervisory experience preferred.
• C.R.C., C.C.M., C.O.H.N., C.R.R.N. or C.D.M.S. certification or eligibility required. Valid driver’s license required. Case Management Certification (CCM, CDMS, CRC, CRRN, COHN) must be completed within 6 months of joining the Catastrophic Program.  Other professional certifications desirable. Must meet licensing requirements based on applicable statutes of state(s) of practice. Knowledgeable of workers’ compensation laws and practices.