CareFirst Careers

Case Management Director, RN (Federal Employee Program)

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Resp & Qualifications

PRINCIPAL ACCOUNTABILITIES:  reporting to Vice President, PreService, Appeals & Medical Review, the incumbent’s duties would include, but are not limited to, the following:

1. Leads, directs and executes FEP Case Management delivery for CareFirst members.  Works with executive and senior management to develop and implement game changing and innovative case management strategies for the care of FEP members moving from acute and sub-acute facilities and into home-based settings.  The primary focus is on providing integrated care amongst all services and with CareFirst’s Total Care and Cost Improvement Programs.  Develops and implements programs that include innovative arrangements that support program quality, reduce readmission risk, ensures adherence to FEP case management plans and integrates delivery standards.


2.   Demonstrates the value of FEP Case Management to the Federal Government’s Office of Personnel Management and the BCBSA’s Director’s Office as well as key internal and external stakeholders. Produces data analysis and demonstration of key FEP Case Management outcome improvements such as reduction in readmissions and reduction of emergency room visits for the CareFirst FEP population.


3. Leads the collaborative effort with CareFirst’s Technical and Operations Support and Data and Informatics resources to assure FEP systems and reports are in place to support the effective implementation and ongoing management of developed strategies.  Assures that all related vendors, networks and stakeholder systems are integrated appropriately and FEP case management plans are functioning at the highest possible level.


4. As the leader within Total Care and Cost Improvement (TCCI) and Patient Centered Medical Home (PCMH), the Director is responsible for proactively integrating with all CareFirst TCCI and PCMH related programs and stakeholders. Engages and collaborates with the Leadership Team to ensure all TCCI and PCMH programs are aligned and effectively measures results, reinforcing CareFirst’s position as an industry leader in care management strategies.

5. Staff Management: Reviews staffing goals and expectations to ensure that each is consistent and adequate to meet department goals.  Evaluates performance of each team member, generates development plans and sets goals within the context of the corporate policy.  Provides coaching, counseling and motivation to team members ensuring staff has the appropriate tools and training.  Develops departmental staff to continuously enhance innovation and consistency of delivery of complex case management.  Plans and manages the departmental budget.


QUALIFICATIONS:

Required Experience/Skills/Abilities: 

  • RN Active Nursing License in Maryland, DC or Virginia
  • Bachelor’s degree in nursing, public health, business or related field
  • Minimum of  8 years of management experience in healthcare environment, health insurance payor environment, or related industry; and a minimum of 5 years’ experience in at least one of the following: complex case Management or complex care coordination. 
  • Experience and knowledge of the episodic management of acute and chronic condition(s) and nationally recognized case management guidelines and protocol(s), to meet all program and regulatory requirements. 
  • Demonstrated leadership experience including successful matrix management and experience directing successfully integrated IT strategies.
  • Ability to identify solutions to complex business issues, to make difficult decisions, to achieve results through others, and to motivate team effort and cooperation. 
  • Ability to inspire, motivate and guide others toward goal accomplishments. Encourages and facilitates cooperation within the organization and with customer groups; fosters commitment, team spirit, pride, trust.  Develops leadership in others through coaching, mentoring, rewarding and guiding associates.
  • A strong balance between clinical expertise and business acumen that will ensure the most expedient delivery of case management strategies and solutions.
  • Exceptional project and resource management skills.
  • Excellent written and presentation skills appropriate for senior level executive, stakeholder and account communications.


Preferred:  Advanced degree or graduate level coursework in Business, Nursing, or Health Care Management.  Prior Health insurance industry exposure, preferably in government account management or public sector products. Active Certified Case Manager (CCM) certification.

Department

Department: Case Management

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.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

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

Closing Date

Please apply before: 7/13/2018

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 physical demands described below are representative of those that must be met by an associate to perform the essential duties and responsibilities of the position successfully.  Requirements may be modified to accommodate individuals with disabilities. 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 employee must frequently talk and hear.  Weights of up to 25 pounds are occasionally lifted.  Frequent driving is required.

Sponsorship in US

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

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