Capital Blue Cross · 2 hours ago
Care Management Team Lead
Harrisburg, PA
Full-time
Hybrid
Senior Level
5+ years expCapital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association, dedicated to improving the health and well-being of its members and communities. The Care Management Team Lead oversees daily operations of the Care Management unit, ensuring compliance and evaluating productivity while mentoring staff and facilitating care planning.
ConsultingHealth CareHealth InsuranceProfessional Services
Responsibilities
Facilitates ongoing staff development. Acts as mentor to the care management staff by providing regular feedback regarding their performance identifying strengths and plans for areas of improvement
Demonstrates ongoing oversight of care management activities. Evaluates performance metrics including but not limited to utilization trends, engagement rates, staff productivity, patient satisfaction and other department/organizational metrics. Identifies, develops and/or implements plans at the department, program, and/or member level to achieve results
Supports care management staff in care planning and troubleshooting complex problems and Members’ needs, resource constraints, provider issues etc. Promotes interdisciplinary team collaboration and communicates needs, issues, resolution with leadership
Performs quarterly audits (phone calls and documentation review) to ensure accreditation and regulatory compliance, department performance standards met. Works with leadership and staff to resolve identified issues. Completes additional audits as necessary to evaluate and mentor staff
Lead case review to facilitate co-management and multidisciplinary communication
Identifies and reports quality of care issues in accordance with established departmental policies and procedures. Maintains member confidentiality at all times
Attends company and departmental meetings and training sessions as required
Qualification
Required
At least five (5) years' experience as a care manager: Case Manager, Disease Manager, Social Worker or equivalent experience
Registered Nurse with a bachelor's degree (or higher) in a health-related field OR Master's in Social Work degree
Active licensure in home state; additional state licensure as needed to meet customer needs
Strong team skills with the ability to work and interact with management level staff both within and outside of Clinical Management
Excellent critical thinking skills, forward thinking and problem solving skills
Ability to multi-task and handle competing priorities
Excellent time management and organizational skills
Superior clinical process, critical thinking, and problem solving skills; and ability to handle critical situations
Excellent written, oral communication, listening, and organizational skills
Ability to use computer system while conversing telephonically
Able to demonstrate strong customer service skills, including tact and diplomacy, both in person and telephonically
Ability to appropriately prioritize workload and assignments and perform accurate, detailed and timely completion of assigned duties
Ability to work autonomously and as part of an interdisciplinary team
Demonstrates sound judgment that affirms the rights and responsibilities of Member's, families, health care professionals and health care organizations
Ability to operate a personal computer (PC), including proficiency in Microsoft Office Products
Knowledge of NCQA standards for Population Health Management for health plan accreditation, DMAA standards for disease management and CMSA Standards of Practice for Case Management, Act 68, NCQA, CMS and ERISA
Knowledge of clinical and managed care principles and operations
Knowledge of current and emerging medical treatment modalities and best practice guidelines with the ability to analyze and interpret medical and benefit coverage interrelationships
Knowledge of adult learning principles, motivational interviewing and intrinsic coaching techniques
Preferred
Supervisory/leadership experience preferred
Case Management Certification preferred
Subsequent to completing one (1) year in the position, the incumbent must obtain national certification as a case manager
Benefits
Medical, Dental & Vision coverage
Retirement Plan
Generous time off including Paid Time Off
Holidays
Volunteer time off
Incentive Plan
Tuition Reimbursement
Company
Capital Blue Cross
At Capital Blue Cross, we promise to go the extra mile for our team and our community.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Todd Shamash
President and CEO
Glenn Heisey
Executive Vice President and Chief Operating Office
Recent News
2025-10-02
2022-10-14
Company data provided by crunchbase