**JOB PURPOSE:** Responsible for overseeing the day-to-day activities of the Care Management Department and serves as a liaison between Director of Care Management and /or Director of Operations. The person holding this position is delegated the responsibilities for carrying out the assigned duties and responsibilities of U-Direct Care Management Department. **KEY RESPONSIBILITIES:** 1. Knowledge of commercial insurance is fundamental. Knowledge of the Fundamentals of Case Management 2. Ability to communicate effectively with payers, clients and providers essential. 3. Must have working knowledge of computers, including Microsoft office programs. 4. Understanding of state and federal regulations crucial. 5. Implements partner relations practices necessary to establish a positive partner relationship and promote a high level of partner morale. 6. Responsible for recruitment and employment of care management staff, ensuring that they have the necessary qualifications to perform their job descriptions. 7. Participates in the development and implementation of an orientation program for each partner. 8. Responsible for meeting Business drivers and performance goals set by the company. 9. Provides reports to Director or Vice President of Care Management with performance related to business drivers and key performance indicators. 10. Serves as the liaison between Commercial contracted vendor and our customers. 11. Responsible for developing an in-service schedule for the Care Management department that ensures that members of the department have skills necessary to provide quality care. 12. Performs routine chart audits to ensure quality case management. 13. Schedules On-Call duties and provides back-up coverage. 14. Handles all customer complaints expeditiously and according to policy 15. Ensure that Care Management department is meeting company standards of customer service. 16. Maintains the privacy and confidentiality of protected health information, as well as sensitive information pertaining to other partners of U-Direct. 17. Facilitates clear information passage within and among departments involved. 18. Keeps supervisor informed of daily activities and issues. Purposes solutions to all issues. 19. Must get along with co-workers; maintain effective relationships with management staff, partners and the general public. 20. Must deliver exceptional customer service at all times. 21. May be responsible for a small caseload. 22. Performs other roles, administrative tasks and related duties as required by supervisor. 23. Must have timely, regular attendance. 24. Attend professional training as directed. **LICENSURE, CERTIFICATION, and EDUCATION REQUIREMENTS:** Licensed healthcare professional. RN with valid, GA, SC, NC and FL Licenses. BSN preferred. **ADDITIONAL QUALIFICATIONS:** (Preferred qualifications) Minimum of five years nursing experience. 3-5 years management experience preferable in a commercial managed care or case management organization. Or, any equivalent combination of experience and training which provides the required knowledge, skills, and abilities. Freedom from illegal use of drugs, and freedom from use and effects of use of drugs and alcohol in the workplace. Persons who have been found guilty by a court of law of abusing, neglecting or mistreating individuals in a health care related setting are ineligible for employment in this position. Satisfactory results of a criminal history check, Office of the Inspector General Sanction Check, and satisfactory licensure validations (as applicable) **Family Makes Us Stronger.** Our family, your family, one family. Committed to loving, giving, and caring. United in making a difference. We are eager to connect with you! **_Apply Now_** to get started at PruittHealth! _As an Equal Employment Opportunity employer, all qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, disability, or veteran status_