Resp & Qualifications PURPOSE: The Care Management Supervisor will direct and coordinate the activities of the Care Management staff for the Federal Employee Program (FEP) line of business. This role assists leadership with the development and review of Care Management standards, program criteria, policies, and procedures to ensure quality of care and manage health care costs. We are looking for an experienced clinical leader in the greater Baltimore metropolitan area who is willing and able to work in a hybrid model. The incumbent may be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week. The ideal candidate will have previous experience leading Care Management functions in a payor organization and will be familiar with the Federal Employee Program line of business. Bilingual-fluent in Spanish a big plus!
ESSENTIAL FUNCTIONS: - Provides direct supervision, mentorship and support to care management staff, Oversees scheduling, workload distribution, and daily operations to ensure optimal staffing and coverage.
- Oversees and participates in care coordination activities including case management and disease management to ensure effective transition across levels of care.
- Assists the Manager and Director with the development, design, and implementation of new Care Management programs and initiatives. Participates in the evaluation of annual plans and Care Management initiatives to assist leadership in meeting the evolving needs in the organization, competitors and marketplace.
- Collaborates with physicians, nursing and hospital leaders to ensure service expectations are being met.
SUPERVISORY RESPONSIBILITY: This position manages people.
QUALIFICATIONS: Education Level: Bachelor's Degree in Registered Nursing OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
Licenses/Certifications Upon Hire Required: - Health Services\RN - Active Registered Nurse - DC or VA State Licensure and/or Compact State Licensure and CCM
Experience: 3 years Care Management, Discharge Coordination, Home Health, Utilization Review, Disease Management or other direct patient care experience with demonstrated leadership skills
Preferred Qualifications:
- Previous experience in a payor organization. Bi-lingual; Spanish speaking.
Knowledge, Skills and Abilities (KSAs) - Ability to communicate effectively verbally and in writing.
- Knowledge of health benefits industry, products, trends, consumer market, and competitive intelligence.
- Knowledge and proficiency in use of metrics and measures in managing programs and services.
- Strong organizational skills to manage multiple projects, issues and priorities.
- Basic understanding of the strategic and financial goals of a health care system or payor organization, as well as health plan or health insurance operations (e.g. networks, eligibility, benefits).
- Knowledge of managed care principles and concepts including Health Plan Employer Data and Information Sheet (HEDIS) and knowledge of the standards of practice for case managers.
- Ability to mentor and coach associates to accomplish goals, provide objective evaluation of associate performance, and implement strategies to improve individual and team-based performance as needed.
- Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Salary Range: $82,800 - $170,775
Salary Range Disclaimer The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).
PHYSICAL DEMANDS:The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
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