Resp & Qualifications

PURPOSE:

The Manager supports the Director of Behavioral Health Services and the CareFirst Mission of providing affordable health insurance and accessible health care to all. The incumbent builds an effective, efficient workforce to support all aspects of the Behavioral Health Services department across the continuum of care settings and clinical programs and services for members. This includes the planning, implementation, and refinement of care coordination programs and initiatives for behavioral health services that support departmental and divisional goals.

Note: We are looking for an experienced people leader in the Baltimore/Washington DC metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week.

ESSENTIAL FUNCTIONS:

• Manages, directs and coordinates the activities of clinical and non-clinical team members to ensure that departmental goals are met through appropriate coordination of behavioral health care services and compliance with care management policies/procedures, as well as regulatory and CareFirsts accreditation standards. Collaborates within an interdisciplinary framework with other CareFirst departments and clinical vendor partners to ensure optimal delivery of quality, cost effective care coordination and that best practices are in place. Evaluates current state and future state EHR systems for functional inefficiencies, working with IT to develop enhancements and executes plans for improvements and implementation.

• Manages the strategic and the day-to-day activities of the Department, including coaching and guiding individuals and teams in order to implement departmental, divisional, and organizational mission/goals. Recruits, retains and develops a high performing team. Evaluates performance of each team member, generates development plans and sets goals within the context of the corporate policies and procedures. Develops annual goals, and prepares, monitors, and analyzes variances of departmental budgets in order to control and appropriately allocate resources.

• Manages the implementation of Behavioral Health Services policies, Behavioral Health Care Coordination processes and procedures, and NCQA standards for appropriateness of setting, quality and cost-effective care for all lines of business and for all continuums of care. Maintains current knowledge of regulatory and/or accreditation standards and ensures that the required elements for the standards are current and incorporated in the departmental care coordination processes. Uses/analyzes data to provide insight regarding trends, staffing, case load ratio, etc., that could impact the care coordination process and/or the development, design and implementation of new Clinical CareFirst Programs.

• Monitors monthly metrics and dashboards in collaboration with other levels of leadership to monitor and achieve departmental goals for reducing inpatient admissions and emergency room visits, while increasing visits and/or appropriate follow-up with members behavioral health care providers. Ensures that resources are being utilized appropriately and uses metrics to drive performance. Compiles and presents status of key performance indicators and make recommendations on continuous improvement opportunities to the senior leadership including, but not limited to: customer/case issues, reports, trends/variances, action plans, etc.

• Performs projects or other tasks as delegated in support of the Health Services operation plan and business needs.

SUPERVISORY RESPONSIBILITY:

This position manages people.

QUALIFICATIONS:

Education Level: Master's Degree in Social work, Psychology or Counseling.

Licenses/Certifications Required:

• LCSW- License Clinical Social Worker or

• LMAFT - Lic-Marriage & Family Therapy or

• LPC-Licensed Professional Counselor

• Must be licensed in at least one of the following 3 states and or jurisdictions and meet credentialing requirements for independent practice: Maryland, DC, Virginia .

Experience: 5 years Behavioral health experience with progressively increasing responsibility. 1-year Supervisory experience or demonstrated progressive leadership experience.

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.

• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Salary Range: $89,120 - $165,429

Tra vel Requirements

Estimate Amount: 10% Visit Providers, Conferences, Off-site meetings.

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

Behavioral Health Care Manager

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) 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.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

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.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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REQNUMBER: 19685