Care Manager II, Specialty Programs

Horizon Blue Cross Blue Shield of New Jersey•Hopewell, NJ

About The Position

The Care Manager II– Specialty Programs serves as mentor/preceptor/trainer to new care managers in the CCDM department. The incumbent will perform duties and facilitate care management as assigned. This position serves as the subject matter expert for their specialized population and will actively participate in projects and committees.

Requirements

Requires a license as an RN, or Bachelor degrees in social work, health or behavioral science.
Requires a minimum of five (5) years’ experience working with special needs.
Requires strong knowledge of the standards of practice for case managers.
Requires strong knowledge of managed care principles.
Requires advanced knowledge of specialty population, as applicable.
Requires strong organizational skills.
Requires presentation skills and ability to conduct trainings to teams.
Requires the ability to provide constructive feedback and mentorship to team members.
Requires strong oral and written communication skills.
Requires good PC skills and the ability to utilize Microsoft Office applications (Excel, Access, Word, etc.)
Requires good problem solving and conflict resolution skills.
Requires a car with valid New Jersey State License and Insurance for certain positions.

Nice To Haves

Graduate level degree in Social Work or Health and Behavioral Science preferred.

Responsibilities

Responsible for performing care manager duties using established guidelines to ensure appropriate level of care for our members while preparing new hires to independently transition to the care manager role.
Coordinate the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of care.
Evaluate the appropriateness and efficiency of all services designed to meet the member’s needs.
Coordinates and assists in implementation of care plan for members.
Act as subject matter expert for respective area for mentoring/ preceptor /training/remediation classes.
Conduct training and presentations in team meetings and facilitate ad-hoc training activities.
Participate in department workgroups to drive internal process changes and efficiencies.
Provide reports and feedback on mentees progress to assigned Supervisor as part of the orientation process; assist in the development of plan to identify opportunities for improvement.
Act as a subject matter expert and participate in user acceptance testing for medical management system.
Evaluates care management processes by problem solving, analyzing variances, and participating in the quality improvement program to enhance trained staff outcomes.
Participate in audit activities including IPRO, NCQA, or any other ad-hoc state audits.