CareFirst Careers

Sr. Care Manager (DC Medicaid)

Resp & Qualifications

 

POSITION SUMMARY:

The Senior Care Manager works in conjunction with other members of the interdisciplinary care team using a proactive approach to facilitate effective and efficient member care management. The Senior Care Manager demonstrates initiative and self-direction in managing and providing oversight for Care Managers and Social Workers and other staff as assigned. This position is a working management position; the Senior Care Manager will perform all functions of Care Management in addition to supervising and ensuring staffing and performance within the Care Management unit.

 

Participates in providing member specific care management standards as directed, and follows clinical service and operational excellence standards to ensure performance goals, objectives and targets including member satisfaction, quality, utilization and health outcomes are met.

 

ESSENTIAL JOB RESPONSIBILITIES:

 

  • The Senior Care Manager Manages and delivers utilization intake, review and communication services in compliance with NCQA accreditation standards and government contract requirements. Applies best practices, lessons learned and innovations as appropriate.
  • The Senior Care Manager works in conjunction with other members of the interdisciplinary care team using a proactive approach to facilitate effective and efficient member care management.
    • Facilitate effective and efficient member care management. Members and/or family members are contacted and data is used for comprehensive initial health risk appraisal and other assessments are performed, taking into account members’ needs, current and prospective functional capacities, resources and support systems.
    • Follow-up visits and phone calls with members and/or families as needed
    • Accurate and timely utilization review of member clinical care management charts to insure appropriate contact and utilization of resources based on member’s level of care management.
    • Active communication with other care team members including behavioral health care and utilization managers, physicians and others regarding treatment criteria, care planning and management, and how to render services in the most cost effective setting 
    • Collaborative formulation of appropriate and realistic member-centered care plans including the arrangement of any necessary follow-up services such as durable medical equipment, home health and/or placement in other care settings
    • Advocacy in support of the member’s right to self-determination
    • Acting as a liaison between members, families, CareFirst care team members including CareFirst members (includes community health workers, pharmacists, care coordinators, outreach coordinators, as needed etc.) as well as physicians, community service providers, others
    • Community information and referral management
    • Thorough and timely documentation regarding the members’ problems, goals, plans and/or relevant care management interventions
    • Participation in and/or facilitation of interdisciplinary care team conferences
  • Analyzes care management and social work functions, data and performance. Prepares, reviews and continually improves performance related to level of care management assignment, contact and other process requirements and health outcomes.
  • Maintains regular and candid communication with the director to advise of unit priorities and challenges and to recommend improvements.
  • Provides oversight and direction of unit operations.
  • Makes workload changes as appropriate and necessary to optimize resource utilization and meet performance targets.
  • Oversees daily operations of assigned staff and approves time and attendance.
  • Participates in budgeting processes as needed and monitors unit adherence.
  • Maintains communication among staff members in the department.
  • Assists director with employee performance evaluations, counseling, and interview process.
  • Adheres and upholds all service behaviors and CareFirst core values.
  • Meets assigned project deliverables on time, on budget and with the quality expected.
  • Employee’s conduct must reflect the Company’s values and a commitment to the Code of Conduct ethics and compliance program.
  • Other duties as assigned.

  

Qualifications

 

KNOWLEDGE, SKILLS AND ABILITIES:

Required:  Comprehends complex clinical data. Computer and management reporting and analysis skills. Organizes, prioritizes, and manages time effectively.  Ability to learn quickly and be flexible.  Requires effective interpersonal and communication skills, both written and verbal, and the discretion to manage confidential patient information from medical records and other internal and external sources.  Possesses the ability to make decisions of a highly complex nature with minimal direct supervision.  Maintains strict confidentiality of all data and information. Exercises discretion in all interactions and maintains a reputation of trustworthiness among peers and medical staff.

 

 

EDUCATION AND EXPERIENCE:

Required: 

Graduate of accredited Bachelor’s Degree in Nursing or higher level education 

Knowledge of and experience using ICDs in the practice of clinical care and care management

Five years of Case Management experience

 

Additionally Preferred:

Two years of supervisory or management experience

 

LICENSES AND CERTIFICATES:

Required: 

Current RN License

 

Additionally Preferred:

Current LCSW

  

REPORTING RELATIONSHIP:

Reports to:  Director of Care Management 

Positions supervised:  Care Managers and Social Workers

#LI- TW1

Department

Department:

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:6/6/2020

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

Learn more about Medical Management