MLTSS Care Manager Lead

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

10d•$79,100 - $105,945•Onsite

About The Position

This field-based position is responsible for performing MLTSS Care Manager duties using established guidelines to ensure appropriate level of care for our members as well as preparing new hires to independently transition to the MLTSS care manager role.

Requirements

Requires a minimum of three (3) broad clinical experience.
Requires a minimum of three (3) years’ experience in home care, discharge planning, or case management. Preferably with the elderly frail population.
Requires a current NJ Choice certification in the State of NJ.
Requires strong knowledge of the MLTSS care management role.
Requires strong communication and presentation skills.
Requires the ability to work independently and resolve problems through interaction with multiply departments and personnel.
Requires strong knowledge of the MLTSS care management role.
Requires local travel and possible on call work specific to the managed long term support and services case management program.
Current NJ Choice Certification.
Active Unrestricted NJ RN/SW License Preferred.
Current Driver’s license.

Nice To Haves

Minimum of two (2) years' experience in the Managed Care industry preferred.
Minimum of two (2) years' experience as an MLTSS Care manager in the managed care industry preferred.

Responsibilities

Acts as subject matter expert for respective area for mentoring/ preceptor/ training/ remediation classes.
May assume training type activities/presentations in team meetings/training classes.
Present reports required on mentees’ progress to assigned Supervisor that focus on positive outcomes and opportunities for improvement.
Subject matter expert for user acceptance testing for medical management system and all MLTSS State required contractual assessments and surveys.
Evaluates care management processes by problem solving, analyzing variances and participating in the quality improvement program to enhance trained staff outcomes ongoing in the MLTSS program.
Must follow current Care Management role and responsibilities to include but not limited to: Evaluates the necessity, appropriateness and efficiency of medical services and procedures provided.
Coordinates and assists in implementation of plan for members.
Coordinates the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of care.
Willing to travel to different regions in State as needed for demand and training as needed.
Lead CM will serve as a 1:1 resource to assist the new assessor to become fully certified and independent in the assessor role.
Lead CM will ensure protocols for identifying and addressing any retraining needs for new assessor.
Lead CM is required to percept the new assessor for one month or longer as needed post NJ Choice certification.
Lead CM is to have the new assessor shadow them on all workdays and share a case load.
Lead CM will be responsible to communicate with new assessor as to progress and timeline for working independently.