DSNP RN/SW Supervisor-Atlantic County, NJ

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey's health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.

Responsibilities

• Supervises, analyzes and coordinates the daily activities of the unit to ensure departmental productive goals are met with regards to quality timeliness, accuracy and consistency of medical decisions.
• Continuously evaluates workflow issues and seeks to improve processes that impact the Department.
• Coordinates data collection, reviews compliance reports and identifies opportunities for service improvements.
• Recommends, develops and implements department policies and procedures and interfaces with other areas to insure consistent applications.
• Serves as liaison between Medical Directors and staff.
• Manage, direct, and develop staff by providing feedback and coaching. Administer performance, and salary reviews for staff. Ensure staff meets all regulatory requirements and utilizes best practice methodology.
• Performs the functional operational duties of a specific clinical care team member as needed.
• Ensures an atmosphere within the team, which fosters open communication, teamwork, ownership, and empowerment to make decisions.
• Develops key performance indicators to evaluate level of service for internal and external customers.
• Acts as technical expert and reference point for difficult and complex matters.
• Facilitates the creation of service and processing innovations within the team. Shares innovations with other teams and market divisions.
• Assists in preparing and monitoring the budget to ensure administrative cost objectives are met. Identifies and implements cost saving/revenue generating opportunities.
• Interprets and executes policies for the team.
• Participates in special projects initiated by the Plan.
• Assists Manager in coordinating regulatory, quality and accreditation activities.
• Represents the Plan with external customers, providers and agencies.
• Represents the department on internal committees.
• Mentors the clinical staff in case presentation process.
• Performs other duties as assigned by management.

Education/Experience:

Required Education/Experience:
Individuals who directly supervise SNP, MLTSS, and Exchange Population Staff must have at least one of the following qualifications:

• A Bachelor's degree (or higher) in a health related field and licensure as a health professional (RN, LSW).
• Professional certification in a clinical specialty or at least three years- experience as a case manager
• Prefers certification as a case manager.

Additional Experience:

• Requires two to four years- full time acute healthcare/direct clinical care experience to the consumer. Prefer experience with the elderly, frail and those with chronic conditions.
• Prefers one-year experience as a supervisor.
• Prefers one to three years- experience in the health insurance industry.

Additional licensing, certifications, registrations:

• Requires an active NJ Registered Nurse License or certification in Social Work as appropriate to the business unit.
• Prefers Case Manager Certification.
• Prefers certification in a clinical specialty as appropriate to the business unit.
• Requires a valid Driver's License and Insurance.

Knowledge:

• Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Microsoft Outlook. Should be knowledgeable in the use of intranet and internet applications.
• Requires knowledge of Utilization Management (UM) and managed care principles as they relate to the CCM process and Disease Management process and the Elderly/Frail/Managed Medicaid Population based CM.
• Requires knowledge of the Case Management/Disease Management Standards of Practice.
• Requires knowledge of health care systems and medical documentation.
• Requires understanding of claims processing, contracting and enrollment.
• Requires knowledge of State Mandates and Regulations, including HIPAA and HCQA.
• Requires knowledge of regulatory bodies and their processes including HCFA and DOBI.
• Requires knowledge of NCQA and URAC accreditation criteria related specifically to UM/DM and Case Management
• Requires knowledge of community health resources.
• Prefers knowledge and application of principles of the SNP Model of Care.

Skills and Abilities:

• Action oriented
• Analytical
• Approachability
• Compassion
• Conflict Management
• Delegation
• Managing & Measuring
• Motivating Others
• Negotiating
• Organizational Agility
• Planning/Prioritizing
• Problem Solving
• Presentation Skills
• Listening/Written/Oral Communication Skills
• Process Management
• Strategic Agility

Travel:

• Travel primarily within State of NJ may be required. Occasional travel in the tri-state area may also be required.
• Positions for the exchange population &/or MLTSS are field based and will require travel.

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Salary Range:

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement

Disclaimer:
This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.