Care Management Manager (Hybrid)

PURPOSE

Provides management and assessment of overall FEP PPO care management program. The ideal candidate will have direct experience with FEP PPO line of business and people leading experience as well as their CCM certification.

Essential Functions

• Manages and develops and maintains quality-improvement programs to optimize patient care for the FEP PPO line of business.
• Collaborates with physicians, nursing and hospital leaders to ensure service expectations are being met.
• Manages care management staff.
• Develops and leads team.
• Conducts care coordination activities including case management and disease management.
• Supervises care management staff.

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. Certified Care Management (CCM) certification.

Preferred Qualifications

• Direct experience with FEP PPO line of business.

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.

Salary Range

$99,920 - $185,477

Equal Employment Opportunity

CareFirst is an Equal Opportunity 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.

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.