Resp & Qualifications

The candidate's primary residence must be within the Prince George's County/Montgomery County/Washington DC or Northern Virginia metropolitan area.

PURPOSE:

The Inpatient Management Care Management Supervisor will direct and coordinate the activities of both telephonic and onsite Clinical Navigators embedded at or assigned to 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 initially support telephonic Clinical Navigators and as business needs evolve, 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.  

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.

Licenses/Certifications Upon Hire Required:

• Health Services\RN  - Registered Nurse - State Licensure and/or Compact State Licensure.

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)
• 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.

** Onsite hospital assignments are subject to change based on evolving business needs.

Salary Range:  $79,632 - $164,241

Salary Range Disclaimer