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DSNP Clinical Manager

Horizon Blue Cross Blue Shield

This is a Full-time position in Hopewell, NJ posted February 22, 2021.

Job Summary:This position is responsible for ensuring the operations and compliance with established protocols.

Assists Dual Special Needs Plan (DSNP) Director in establishing, interpreting and implementing new and existing company policies and procedures.

Also responsible for analyzing DSNP utilization and performance trends and ensures quality health care is delivered in a timely, cost effective manner.Responsibilities:* .Directs DSNP staff to ensure overall client satisfaction and appropriate level of service delivery.* Ensures DNSP 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 DSNP 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.* Assists in preparing and monitoring the budget to ensure administrative costs are met.* 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* Requires Bachelors degree from an accredited college or university, preferably in a health related field.* 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.* Active Unrestricted NJ RN License Required.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 packagesSkills and Abilities* Requires excellent organizational skills.* Requires excellent oral and written communication skills.* Requires excellent presentation skills.* Requires comprehensive leadership and decision-making skills.* Requires strong analytical skills and ability to report findings in an accurate manner.* Requires ability to think critically and creatively problem solveTravel:* Minimal Local TravelHorizon 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.