KEY REQUIRED SKILLS:

• Project management experience with Excellent Communication skills
• Experience delivering initiatives in a technology environment including estimation, budget and delivery the solutions
• Knowledge of project management tools and methodologies with solid Attention to Detail

RESPONSIBILITIES:

• Manage multiple medium and large projects concurrently.
• Responsible for initiating, planning, executing, controlling, and closing complex application and system implementation projects using a formal project management methodology.
• Oversee the system development and release management processes.
• Oversee client/customer/vendor relations to ensure that service expectations are met.
• Develops detailed project plans, budgets and schedules, including goals, risks, and resource allocation.
• Monitors project metrics for significant deviations in quality, cost, or schedule.
• Monitors all project risks and issues and manages their resolution and impact.

REQUIRED QUALIFICATIONS:

• Minimum 5 years of experience in leading medium to large-sized, moderate to complex enterprise-wide IT projects.
• Strong organizational, planning, analytical, presentation and communication skills.
• Excellent interpersonal skills and customer service skills including the ability to interact with internal and external customers at all levels.
• High Proficiency Level in specific job-related duties and skills are required.
• Microsoft/Other Project Management Tool(s).

PREFERRED Skills/Experience:

• Healthcare industry experience is preferred
• Mainframe and distributed application development or support experience
• Analysis experience preferred
• Experience using the following technologies and concepts: ETL – Informatica, Adhoc Reporting- Business Objects, and/or Java
• MS Excel, MS Word. MS PowerPoint and MS Visio.
• JIRA

EDUCATION/CERTIFICATIONS:

• Bachelor’s degree in related field preferred or equivalent work experience
• Project Management Institute’s certification preferred.
• Master’s degree in Computer Science preferred
• Certified Scrum Master (CSM) certification preferred.

“The Care Manager RN leads the coordination of a multidisciplinary team to deliver a holistic, person centric care management program to a diverse health plan population with a variety of health and social needs. They serve as the single point of contact for members, caregivers, and providers using a variety of communication channels including phone calls, emails, text messages and the BCBSM online messaging platform. The Care Manager RN uses the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the member’s health across the care continuum. They work in partnership with the member, providers of care and community resources to develop and implement the plan of care and achieve stated goals.

ESSENTIAL DUTIES AND RESPONSIBILITIES (Other duties may be assigned):

• Lead the coordination of a regionally aligned, multidisciplinary team to provide holistic care to meet member needs telephonic and/or digitally. The multidisciplinary team is inclusive of Medical and Behavioural Health Social Workers, Registered Dietitians, Pharmacists, Clinical Support Staff and Medical Directors.
• Use the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the members’ health across the care continuum.
• Assess the member’s health, psychosocial needs, cultural preferences, and support systems.
• Engage the member and/or caregiver to develop an individualized plan of care, address barriers, identify gaps in care, and promotes improved overall health outcomes.
• Arrange resources necessary to meet identified needs (e.g., community resources, mental health services, substance abuse services, financial support services and disease-specific services).
• Coordinate care delivery and support among member support systems, including providers, community-based agencies, and family.
• Advocate for members and promote self-advocacy.
• Deliver education to include health literacy, self-management skills, medication plans, and nutrition. Monitor and evaluate effectiveness of the care management plan, assess adherence to care plan to ensure progress to goals and adjust and re-evaluate as necessary.
• Accurately document interactions that support management of the members.
• Prepare the member and/or caregiver for discharge from a facility to home or for transfer to another healthcare facility to support continuity of care.
• Educate the member and/or caregiver about post-transition care and needed follow-up, summarizing what happened during an episode of care.
• Secure durable medical equipment and transportation services and communicate this to the member and/or caregiver and to key individuals at the receiving facility or home care agency.
• Adhere to professional standards as outlined by protocols, rules and guidelines meeting quality and production goals.
• Continue professional development by completing relevant continuing education and maintaining Certified Case Manager (CCM).

EDUCATION AND EXPERIENCE

• Nursing Diploma or Associates degree in nursing required.
• Bachelor’s degree in nursing strongly preferred.
• 3 years of clinical nursing experience in a clinical, acute/post-acute care, and community setting required.
• 1 year of case management experience in a managed care setting strongly preferred.
• Experience managing patients telephonically and via digital channels (mobile applications and messaging) preferred.

CERTIFICATES, LICENSES, REGISTRATIONS

• Current, active, and unrestricted Michigan Registered Nurse license required
• Certification in Case Management (CCM) required or to be obtained within 18 months of hire
• Certification in Chronic Care Professional (CCP) preferred

QUALIFICATIONS

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

OTHER SKILLS AND ABILITIES

• Ability to think critically, be decisive, and problem solve a variety of topics that can impact a member’s outcomes.
• Empathetic, supportive and a good listener.
• Proficient in motivational interviewing skills.
• Demonstrated time management skills.
• Organizational skills with the ability to manage multiple systems/tools, while simultaneously interacting with a member.
• Must have intermediate computer knowledge, typing capability and proficiency in Microsoft programs (Excel, OneNote, Outlook, Teams, Word, etc.).
• Must embrace teamwork but can also work independently.
• Excellent interpersonal and communication skills both written and verbal.”

TOP THREE SKILLS/EXPERIENCE

• Minimum 3-5 years JAVA/J2EE/J2SE development experience, preferably gained on multi-tier web-based business applications
• Minimum 3-5 years working with standard J2EE development frameworks
• Minimum 1-2 years of MS Access, Cold fusion development experience

ENGAGEMENT DESCRIPTION (WEB APP DEV)

• Solid Java developer with hands-on experience analyzing, developing and maintaining large scale, mission critical applications in a multi-platform J2EE, J2SE, and web systems environment.
• Works with the front-end web developers and DBA’s to deliver a rich experience for users
• Develops programs which interact with complex databases and communication protocols
• Codes with future proofing and re-usability of code in mind and fully aware of the effects of certain coding practices
• Interfaces with senior technical staff to explore and suggest strategic technical solutions
• Monitors work against the production schedule and produce progress updates, reporting issues or technical difficulties to senior colleagues routinely
• Responsible for work quality and process as well as that of the wider team, ensuring it meets the team’s and corporate technical standards
• Takes responsibility for technical documentation, ensuring that all work carried out is tested, well documented, and accessible to all parties
• Applies relevant design, coding and documentation standards as required
• Ensures appropriate quality standards are applied to all design and development work

REQUIRED SKILLS/EXPERIENCE

• Minimum 3-5 years JAVA/J2EE/J2SE development experience, preferably gained on multi-tier web-based business applications
• Knowledge and experience of working with Spring, Hibernate, Struts2, Maven, SQL, XML, Tag Libraries JSPs, JavaScript and JQuery
• Minimum 1-2 years building MS Access applications
• Minimum 1-2 years designing / updating SQL and Oracle databases
• End-to-end understanding of common SDLC models and artifacts
• Demonstrated ability to quickly and effectively understand and translate product and business requirements into technical solutions
• Excellent documentation skills, experience creating multiple conceptual design and detail design documents
• Comprehensive unit and functional testing experience to ensure code quality
• Experienced in team-focused working environment
• Able to apply structured thinking, simplifying complex problems into component parts
• Able to think ahead in order to establish an efficient and appropriate course of action for self and others
• Strong communication skills; able to get one’s message understood clearly by adopting a range of styles, tools and techniques appropriate to the audience and the nature of the information
• Takes a proactive approach to work without close supervision
• Maintains personal effectiveness, embracing challenging deadlines, change and complex problem solving, approaching tasks with motivation and commitment

PREFERRED SKILLS/EXPERIENCE

• Previous healthcare experience
• Development of ColdFusion, MS Access and C# applications
• Experienced using industry standard Java IDE’s
• Experienced in Service Oriented Architecture development

EDUCATIONAL REQUIREMENTS

• Bachelor’s degree in a related field preferred

Engagement Description – Pharmacy technician will work in a provider call center with pharmacy services intaking requests for prior authorizations and handling inquiries related to general utilization management claims rejections for both Blue Care Network and Blue Cross Blue Shield of Michigan commercial members.

TOP 3 REQUIRED SKILLS/EXPERIENCE

• Excellent knowledge of pharmacy benefit drugs and utilization management
• Excellent computer skills utilizing web-based applications and windows 10
• Ability to professionally service provider calls in a call center environment

REQUIRED SKILLS/EXPERIENCE

• Excellent written and verbal communication skills
• Ability to problem solve and resolve issues referencing desk level procedures
• Comfort with ambiguity in an area where processes and procedures are updated on a daily basis
• Attention to detail to ensure adherence to NCQA standards and time frames

PREFERRED SKILLS/EXPERIENCE –

• Prior Health plan experience a plus
• Specialty pharmacy experience a plus
• Medical benefit drug billing and utilization management experience a plus

EDUCATION/CERTIFICATIONS

• Michigan license as a pharmacy technician

TOP 3 REQUIRED SKILLS/EXPERIENCE –

• Excellent communication skills.
• Knowledge of Project Management methodologies, including project plan analysis, work breakdown structure, meeting scheduling and notes, and action Item and issue management.
• Attention to detail and quality of data and processes.

REQUIRED SKILLS/EXPERIENCE  

• Working knowledge of Medicare or Medicare Advantage or other Payer business processes & experience and/or related Provider Medical business processes.
• Excellent communication skills.
• Knowledgeable of project management methodologies
• Knowledgeable on all Microsoft tools (MS Outlook, MS Word, MS Excel, MS Project, MS PowerPoint, MS TEAMS)
• Working knowledge of MS Project.
• Working knowledge of MS Visio.
• Working knowledge of SharePoint.
• Working knowledge of MS Teams.

PREFERRED SKILLS/EXPERIENCE – OPTIONAL

• Project management training or certification (CAPM or PMP) preferred.
• Minimum 5-7 years’ health care related experience preferred.

EDUCATION/CERTIFICATIONS

• Bachelor’s Degree preferred.
• PMP or CAPM Certification preferred.