CareFirst Careers

Care Management Manager (Hybrid)

Resp & Qualifications

PURPOSE: 
Reporting directly to the Director of Care Management/Inpatient Management, provides management and oversight, of Inpatient Clinical Navigators. The candidates must be familiar with MCG and the Concurrent Review process for hospital admissions. The Manager provides support to confirm adherence to policies, and procedures to promote quality of care and manage health care costs.  This position will require onsite presence at participating area hospitals 2 or more days a week. May also be required to attend meetings at the CareFirst office locations. This role will function as a liaison to facilitate positive relationships with hospitals teams to work collaboratively for timely and smooth transitions from inpatient care to a lower level of care or home.  The Manager position utilizes experience and skills in both case management and concurrent review within utilization management. Candidate's primary residence within the greater Baltimore Metropolitan area. 


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 inpatient management staff. Develops and leads team.
  • Conducts care coordination activities including utilization management, concurrent review and case management.


SUPERVISORY RESPONSIBILITY:
This position manages people.


QUALIFICATIONS:

Licenses/Certifications: RN - Registered Nurse - State Licensure and/or Compact State Licensure  Upon Hire Required.

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.


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. 





Salary Range: $93,760 - $174,042

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 responsibilites 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).

Department

Maryland Inpatient Onsite

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.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

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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