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Resp & Qualifications

PURPOSE:

This hybrid position will lead a Maryland Medicaid Care Management team of approximately 50 associates. The ideal candidate will have previous Medicaid experience with the ability to develop, implement, and oversee programs that achieve Medicaid regulatory compliance and organizational performance objectives. Provides management and assessment through data and analytics of overall care management program. Implements programs and initiatives to form a comprehensive and cohesive model that effectively identifies high-risk members. Manages the delivery of effective interventions, and tracks outcomes across the organization. Manages and evaluates care management services offered and works closely with leadership, physicians/providers, and other service lines in a highly matrixed environment. This role requires candidates to be located in the Maryland, Washington, DC, or Northern Virginia (DMV) area. The incumbent will 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.

ESSENTIAL FUNCTIONS:

• Manages and develops and maintains quality-improvement programs to optimize patient care.

• Collaborates with physicians, nursing and hospital leaders to ensure service expectations are being met.

• Manages care management staff. Develops and leads team.

• Conducts care coordination activities including case management and disease management.

SUPERVISORY RESPONSIBILITY:

This position manages people.

QUALIFICATIONS:

Education Level: Bachelor's Degree in 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.

Experience: 5 years care management experience. 1 year supervisory experience or demonstrated progressive leadership experience.

Preferred Qualifications :

• Previous Medicaid experience with the ability to develop, implement, and oversee programs that achieve Medicaid regulatory compliance and organizational performance objectives.

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.

Licenses/Certifications Required Upon Hire:

• Health Services\RN - Registered Nurse - State Licensure and/or Compact State Licensure

Salary Range: $99,920 - $185,477

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).

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

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.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship.

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REQNUMBER: 22404