MLTSS Supervisor, RN/SW

Job not on LinkedIn

🕒 5 days ago

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

💵 $87.3k - $119.1k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

✨ Supervisor

🚫👨‍🎓 No degree required

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NJM Insurance Group

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1913

Insurance

NJM Insurance Group is a well-established insurance provider offering a range of personal and commercial insurance products. Their services include auto, homeowners, renters, condo, commercial auto, and business insurance, with a focus on exceptional customer satisfaction and claims experience. NJM is recognized for its outstanding auto claims experience by J. D. Power and is committed to serving customers in states like Connecticut, Maryland, New Jersey, Ohio, and Pennsylvania. The company prides itself on being straightforward and customer-focused, without jingles or mascots, offering trusted insurance solutions and multiple discount opportunities for various policies.

📋 Description

• Supervises, analyzes and coordinates the daily activities of the unit • Continuously evaluates workflow issues and seeks to improve processes • Coordinates data collection, reviews compliance reports and identifies opportunities for service improvements • Recommends, develops and implements department policies and procedures • Liaison between Medical Directors and staff • Develops and monitors goals for staff and provides ongoing feedback • Conducts performance reviews on an annual basis and administers salaries for the staff • Directs the employment activities of the office that include staffing, development, and training • Ensures staff meets all regulatory requirements and complies with best practices • Performs the operational duties of a specific clinical care team • Ensures an atmosphere of open communication and teamwork • Develops key performance indicators to evaluate service level • Acts as technical expert and reference point for complex matters • Facilitates the creation of service and processing innovations within the team • Assists in preparing and monitoring the budget

🎯 Requirements

• High School Diploma/GED required • Bachelor degree preferred or relevant experience in lieu of degree • Requires two (2) - four (4) years acute healthcare experience • Prefers one (1) year experience as a supervisor • Prefers one (1)- three (3) years experience in the health insurance industry • Certification as a case manager preferred • Professional certification in a clinical specialty and at least three years experience as a case manager preferred • Active Unrestricted NJ RN/SW License Preferred • Knowledge of Utilization Management (UM) and managed care principles • Knowledge of Case Management/Disease Management Standards of Practice • Knowledge of health care systems and medical documentation • Understanding of claims processing, contracting and enrollment • Knowledge of State Mandates and Regulations, including HIPAA and HCQA • Knowledge of regulatory bodies and their processes including HCFA and DOBI • Knowledge of NCQA and URAC accreditation criteria related specifically to UM/DM and Case Management • Knowledge of community health resources • Requires the ability to express thought clearly and concisely both orally and written • Requires excellent organizational skills • Requires excellent presentation skills • Requires the ability to think analytically and report findings accurately • Requires knowledge of computers and their related software packages

🏖️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement