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DSNP Supervisor, RN
Ref No.: 17-03125
Location: Mt. Laurel, New Jersey
Position Type:Direct Placement
Start Date: 04/20/2017
Job Title : DSNP Supervisor, RN
Location : Mount Laurel, NJ
Description : Job Summary:
The position is responsible for leading the Dual Special Needs Plan (DSNP) clinical care team in a hands-on manner to provide exceptional service to the customer and contain medical claims cost. This is accomplished through active involvement and leading of the day-to-day operations of a clinical care team and ensuring staff is consistent with corporate policies and procedures and are compliant with contractual, state and federal guidelines. Serves as a medical resource to members and providers, and non-clinical staff.
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 seek to improve processes that impact the managed long term support and services 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.
  • Liaison between Medical Directors and staff.
  • Ensures staff meets all regulatory requirements and comprehends and complies with best practices, professional standards, internal policies, and procedures.
  • Performs the operational duties of a specific clinical care team.
  • 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.
  • Assists Manager in coordinating regulatory, quality and accreditation activities.
  • Manage, develop and train staff; develop and monitor goals; conduct annual performance reviews, and administers salaries for the staff.
Knowledge:
  • Requires knowledge of Utilization Management (UM) and managed care principles as they relate to the CCM process and 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.
Skills and Abilities:
  • Requires the ability to express thought clearly and concisely both orally and written.
  • Requires the ability to obtain the skills possessed by the team members and system technical competence.
  • Require the ability to effectively lead team members in diversified tasks.
  • Requires excellent organizational skills.
  • Requires excellent presentation skills.
  • Requires the ability to think analytically and to report findings in an accurate manner.
  • Requires knowledge of computers and their related software packages.
Education/Experience:
  • Requires Bachelors degree from an accredited college or university, preferably in a health related field.
  • Requires a minimum of 2 - 4 years experience in health insurance industry.
  • Requires a minimum of one year direct supervisory experience or demonstrated supervisory experience leading teams in a matrix management environment.
  • Prefer minimum of three years experience as a case manager.
  • Prefer minimum of 18 months experience in the health insurance industry.
Additional licensing, certifications, registrations:
  • Requires active, unrestricted Registered Nurse New Jersey license to practice.
  • Prefers professional certification in a clinical specialty as appropriate to the business unit.
  • Prefer certification as a case manager.
Travel (If Applicable):
  • Minimum local travel required.