Manager, Medicaid Housing Program

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. 

This position is responsible for ensuring the operations and compliance with established protocols. Assists Managed Long-Term Support and Services Director in establishing, interpreting and implementing new and existing company policies and procedures. Also responsible for analyzing managed long-term support and services utilization and performance trends and ensures quality health care is delivered in a timely, cost effective manner. This manager will provide oversight of all housing-related services and housing staff. The manager will be responsible for ensuring coordination of Housing Services with all other services provided to Members. The manager will be responsible for creating an integrated housing strategy as well as housing related policies and procedures and cultivating stakeholder relationship. The manager will coordinate Housing Specialists’ duties. The manager will ensure that the Contractor has the structure and systems in place to ensure successful provision of services to Members in the Healthy Homes or MLTSS programs or transitioning to the community for a nursing facility.

Job Responsibilities:

• Directs managed long-term support and services staff to ensure overall client satisfaction and appropriate level of service delivery.
• Develops and monitors goals for managed long-term support and services staff and provides ongoing feedback and coaching.
• Directs the employment activities of the office including staffing, development, and training.
• Ensures managed long term support and services staff meets comprehends and complies with all regulatory requirements and best practices, professional standards, internal policies, and procedures. Supervises, analyzes and coordinates the daily activities of the managed long term support and services unit to ensure departmental goals are met with regards to timeliness, accuracy and consistency of medical decisions.
• Recognizes opportunities to improve the quality of care/services and activities to continually strive to improve outcomes.
• Represents department on Plan Task Forces/Committees.
• Develops and implements policies and procedures.
• Develops ad hoc reports as required.
• Assists in preparing and monitoring the budget to ensure administrative costs are met.
• Interfaces with other teams and plan areas to assure consistent application of policies and procedures and to facilitate inter-unit/department projects.
• Represents the Plan with external customers, providers and external agencies and represents the unit on corporate issues and/or in the event of Director's absence.
• Manage, develop and train staff; develop and monitor goals; conduct annual performance reviews, and administers salaries for the staff.

Education/Experience:

• High School Diploma/GED required.
• Bachelor degree preferred or relevant experience in lieu of degree.
• Requires five (5) years experience in managed care/healthcare.
• Requires five (5) years clinical experience with elderly frail population.
• Requires three (3) years supervisory experience.
• Prefers professional certification in a clinical specialty and as least 3 years experience as a case manager.

Additional Licensing, Certifications, Registrations:

• Active Unrestricted NJ RN/SW License Preferred. Candidates with a restricted license will not be considered.

Knowledge:

• Requires extensive knowledge of functional tasks performed within managed long term support and services.
• Requires extensive knowledge of Plan products, applications, policies, procedures and systems.
• Requires knowledge in the principles of risk management and quality assurance.
• Requires knowledge with URAC and NCQA standards for accreditation.
• Requires knowledge of computers and their related software packages

Skills and Abilities:

• Requires excellent organizational skills.
• Requires excellent oral and written communication skills.
• Requires excellent presentation skills.
• Requires comprehensive leadership and dec