Care Management Supervisor - Federal Employee Program (Hybrid)

Care Management Supervisor - Federal Employee Program (Hybrid) in Baltimore, MD - CareFirst

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Home / Job Search / Care Management Supervisor - Federal Employee Program (Hybrid)

Care Management Supervisor - Federal Employee Program (Hybrid)

Job ID: 22586

Job Function: Medical Management

Location: Baltimore, MD, United States

Campus: MD-Baltimore-Canton Crossing

Career Band: BDB

Status: Full-Time

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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).

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

#LI-SS1

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Serving Maryland, the District of Columbia, and portions of Virginia, CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueCross BlueShield Medicare Advantage is the shared business name of CareFirst Advantage, Inc., CareFirst Advantage PPO, Inc. and CareFirst Advantage DSNP, Inc. CareFirst BlueCross BlueShield Community Health Plan Maryland is the business name of CareFirst Community Partners, Inc. In the District of Columbia and Maryland, CareFirst MedPlus is the business name of First Care, Inc. In Virginia, CareFirst MedPlus is the business name of First Care, Inc. of Maryland (used in VA by: First Care, Inc.). CareFirst of Maryland, Inc., Group Hospitalization and Medical Services, Inc., CareFirst Advantage, Inc., CareFirst Advantage PPO, Inc., CareFirst Advantage DSNP, Inc., CareFirst Community Partners, Inc., CareFirst BlueCross BlueShield Community Health Plan District of Columbia, CareFirst BlueChoice, Inc., First Care, Inc., and The Dental Network, Inc. are independent licensees of the Blue Cross and Blue Shield Association. BLUE CROSS, BLUE SHIELD and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.

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 generic information.

Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States. To comply with this law, CareFirst must collect information regarding an employee's identity and employment eligibility and document that information on a document referred to as Form I-9, Employment Eligibility Verification, no later than three business days from when the employee begins work for pay. If you are hired, you will be required to provide certain information on the form necessary to establish your identity and eligibility to work in the United States and certain required supporting documents.

If you experience any technical difficulties during this process, please send an email detailing the specific problem you are having to [email protected] and we will respond as soon as possible.

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c) If you believe that you have experienced discrimination, contact OFCCP at 800-397-6251 (TTY 877-889-5627) or www.dol.gov/ofccp.