MLTSS Care Manager Lead

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. About the Role 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. What You'll Do 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. What You Bring Education/Experience: 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. 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. Additional Licensing, Certifications, Registrations: Current NJ Choice Certification. Active Unrestricted NJ RN/SW License Preferred. Current Driver’s license. Knowledge: Requires strong knowledge of the MLTSS care management role. Skills and Abilities: 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. Travel (If Applicable): Requires local travel and possible on call work specific to the managed long term support and services case management program. Why Horizon? At Horizon, you'll do meaningful work that directly improves lives—while being supported by a mission-driven organization that values expertise, collaboration, and growth. We believe that when our people thrive, our communities do too. Salary Range: $79,100 - $105,945 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: Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. 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. #J-18808-Ljbffr Socket.dev