Company Overview and Culture
EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world’s leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have more than 55,000 employees spanning six continents. For more information, visit http://www.exlservice.com.
About EXL Health
We leverage Human Ingenuity and domain expertise to help clients improve outcomes, optimize revenue and maximize profitability across the healthcare ecosystem. Technology, data and analytics are at the heart of our solutions. We collaborate closely with clients to transform how care is delivered, managed and paid.
EXL Health combines deep domain expertise with analytic insights and technology-enabled services to transform how care is delivered, managed, and paid. Leveraging Human Ingenuity, we collaborate with our clients to solve complex problems and enhance their performance with nimble, scalable solutions. With data on more than 260 million lives, we work with hundreds of organizations across the healthcare ecosystem.
We help payers improve member care quality and network performance, manage population risk, and optimize revenue while decreasing administrative waste and reducing health claim expenditures. We help Pharmacy Benefit Managers (PBMs) manage member drug benefits and reduce drug spending while maintaining quality. We help provider organizations proactively manage risk, improve outcomes, and optimize network performance. We provide Life Sciences companies with enriched data, insights through advanced analytics and data visualization tools to get the right treatment to the right patient at the right time.
Registered Nurse Manager, Case Management Operations
As the RN Manager, Case Management Operations you will foster a culture of collaboration, adaptability, and accountability by guiding day to day operations, championing process improvements, and ensuring team members are equipped to succeed through training, feedback, and professional growth opportunities. You will lead a team of remote, telephonic complex care RN case managers to best deliver high quality service to Tricare beneficiaries.
Work schedule Monday - Friday 5 days x 8 hours
Rotating shift times with 2 or 3 days per week starting at 8 am and 11 am.

QUALIFICATIONS:

Required

• Must hold United States citizenship status.
• Ability to obtain Security Clearance required. Current DOD Security Clearance preferred.
• Current, unrestricted RN license in state of residence with multi-state privileges (an active compact state license)
• 2+ years of direct experience managing a clinical team.
• 5+ years of RN experience in a clinical role with responsibilities for direct patient care.
• Bachelor’s degree in nursing from an accredited college, university, or school of nursing required.
• Experience as an RN in case management operations.
• Experience managing RN teams in a remote environment.
• Proficient in Microsoft Office product suite (Word, Excel, PowerPoint, Outlook, Teams) and mobile technologies (laptop, smartphone apps, etc.).

Preferred

• Case Management Certification (CCM preferred).
• Experience as a telephonic RN case manager managing health plan members.
• Experience participating in performance improvement or quality improvement projects.
• Experience working in an NCQA-accredited Case Management program.
• Ability to navigate multiple simultaneous work demands remotely in an effective and professional manner.
• Ability to resolve issues independently and demonstrate ability to multi-task.
• Executive presence, effective communication skills (verbal, written, presentation, interpersonal).
• Commitment to building team skills and fostering a positive work environment.
• Knowledge of payor issues, including Trihealth benefits and contract limitations, provider network issues, and case management initiatives.

• Monitors daily activities of team and serves as a resource to staff as needed to answer or clarify questions, issues, or concerns.
• Assist with coordination and facilitation of regular staff 1:1 meetings, remote team meetings, department meetings, and case rounds with the medical directors.
• Provide direct, confidential coaching and feedback to individual staff regarding quality audit results, along with suggestions for improvement in individual performance as appropriate.
• Provide interview and hiring assistance as directed by the AVP. Collaborates with the Training leaders for new hire orientation and supports the ongoing learning needs of the team.
• Provide ongoing training, mentoring, guidance, coaching, and disciplinary action as directed.
• Conduct corrective action and counseling with staff, as directed by the AVP. Document interventions with staff and communicates outcomes to AVP.
• Document staff performance and assist AVP with conducting performance evaluations.
• Maintain a working knowledge of beneficiary benefits, contracts, case management policies, professional standards of practice, and community resources to ensure that optimum outcomes are achieved.
• Understands the scope of professional licensure and assists team to conduct case management activities consistent with the scope of this licensure.
• Assist teams in recognizing potential or actual risk management issues and follows through with reporting per process. Appropriately escalate issues as needed.
• Identify process-oriented opportunities for improvement to promote effective and efficient case management services.
• Investigative internal research for grievance and complaints and supports resolution as directed by AVP.
• Collaborates and coordinates the activities of the assigned case management staff to ensure adequate staffing, workloads, and time off.
• Assess daily staffing levels needed and regularly communicate operational status of business. Evaluates caseloads for applicable staffing based on eligibility criteria, needs of members, and staff qualifications. Provides recommendations to AVP for staffing levels.
• Participate in projects, committees, meetings, employee engagement initiatives and other activities as directed by the business leadership.
• Maintain CEUs as required by applicable State Board(s) of Nursing and required certifications. Must be willing to obtain and maintain additional licenses as required to meet business needs.
• Effectively collaborate with other managers to facilitate program delivery.