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Resp & Qualifications

PURPOSE:

The Inpatient Management Onsite Care Management Supervisor will direct and coordinate the activities of Onsite Care Management staff, Onsite Clinical Navigators and/or other Registered Nursing roles embedded at a partnering hospital. This role will assist leadership with the development and review of Care Management standards, program criteria, policies, and procedures to ensure quality of care and manage healthcare costs. The incumbent will function as a liaison working onsite at partner hospitals up to 5 days a week. Based on hospital assignments and admission volumes on a week-to-week basis, management may occasionally approve the onsite care management supervisor to perform limited functions telephonically, at its sole discretion.The candidate may also be required to come to the CareFirst office location periodically for meetings, training, or other business-related activities. **The candidate's primary residence must be within the greater Baltimore metropolitan area** . Bilingual - fluent in Spanish a big plus! This position may be eligible for a role-specific onsite payment differential, which does not apply to other positions.

ESSENTIAL FUNCTIONS:

+ Provides direct onsite supervision, mentorship and support to care management staff, clinical navigators and other CareFirst nursing staff working onsite at assigned hospital facility. 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 while collaborating onsite with hospital staff.

+ 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 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:** 3 years Care Management, Discharge Coordination, Home Health, Utilization Review, Disease Management or other direct patient care experience with demonstrated leadership skills.

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.

+ The incumbent will have an onsite hospital-based assignment and must be able to travel onsite to their hospital-based assignment up to 5 days per week, at managements sole discretion. The incumbent is required to have the vaccinations listed below and be appropriately screened (and cleared) for the items listed below. If the incumbent does not have the vaccinations or have been screened (and cleared), they must do so upon acceptance of offer:- TB screening (and repeat annually)- MMR-V Immunity- Influenza Vaccine (Seasonal)- COVID-19

+ The incumbent is required to complete the following training as assigned by Management, including, but not limited to:Infection control basics- TB Awareness- Bloodborne Pathogens (and repeat annually)** Onsite hospital assignments are subject to change based on evolving business needs.

**Licenses/Certifications** :

Health Services\RN - Registered Nurse - State Licensure and/or Compact State Licensure Upon Hire Required.

Salary Range: $79,632 - $164,241

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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REQNUMBER: 21359