Care Management Department Manager

JOB REQUIREMENTS: Group Health Cooperative of South Central Wisconsin.BETTER TOGETHER The Care Management Manager's responsibilities ensurethat the UM department operates efficiently, improving patient outcomesand reducing unnecessary healthcare costs. The Care Management Manageris responsible for the overall operations of the CareManagementDepartment in conducting a program of case management andutilization review for medical and behavioral health. This includeshospital utilization control, discharge planning, consultant referralauthorization, pre-operative coordination, second review of claims, casemanagement and DME authorization/utilization. The incumbent ensures theintegration of care management policies and procedures. They ensure thatmedical and behavioral health care services are medically necessary,appropriate and provided in the most cost-effective setting. Work isperformed under the general direction, guidance, and supervision of theChief Medical Officer. GHC-SCW is a quality driven cooperative built oncollaboration, community involvement, innovation, and belonging. Indedication to the health and well-being of our employees, we offer acomprehensive benefits package that includes health and dentalinsurance, along with paid short-term disability, long-term disability,and life insurance. Additional benefits include a flexible spendingaccount, employee assistance programs, tuition reimbursement, petinsurance, eyewear discounts, and more. Check us out by clicking on ManyTalents, One Mission The Benefits of Working at GHC-SCW. Job SpecificMinimum Qualifications Bachelor of Science degree in nursing from anaccredited college or university; or equivalent combination or educationand work experience in case management /utilization review required.Master's degree in nursing or relevant majorpreferred. Unrestrictedlicense to practice in the State of Wisconsin as a Registered Nurserequired. Possession of Managed Care Nurse Certification (CMCN, CCM orrelevant certificate) is desirable. Certification must be obtainedwithin twelve (12) months from the date of hire. Possession of a validWisconsin Driver License with good driving record. Ability to providepersonal transportation as needed. Minimum of five (5) to seven (7)years' experience in case management, discharge planning/ utilizationreview is required Previous experience in a managed care environment, anacute or ambulatory care setting and/or home care setting preferred.Previous supervisory or management level experience preferred. Strongleadership experience is required. Working knowledge of healthcareadministration in a managed care environment. Knowledge of... For fullinfo follow application link. Group Health Cooperative is an EqualOpportunity Employer and all qualified applicants will receiveconsideration for employment without regard to race, color, religion,sex, sexual orientation, gender identity, national origin, veteranstatus or disability. APPLICATION INSTRUCTIONS: Apply Online:ipc.us/t/9CAC93F588FE4724

Created: 2025-11-01