Care Manager


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Business Experience™, and draws on Rightshore®, its worldwide delivery model.

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is an Equal Opportunity Employer encouraging diversity in the workplace. All
qualified applicants will receive consideration for employment without regard
to race, national origin, gender identity/expression, age, religion,
disability, sexual orientation, genetics, veteran status, marital status or any
other characteristic protected by law.

is a general description of the Duties, Responsibilities and Qualifications
required for this position. Physical, mental, sensory or environmental demands
may be referenced in an attempt to communicate the manner in which this
position traditionally is performed. Whenever necessary to provide individuals
with disabilities an equal employment opportunity, Capgemini will consider
reasonable accommodations that might involve varying job requirements and/or
changing the way this job is performed, provided that such accommodations do
not pose an undue hardship.

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Location: Horsham Township, PA

CHCS Services

Job Description

Job Title: Senior Manager - LTC Care
Management & Nurse Navigator

Department: Long Term Care – Care

Reports To: Associate Director -

Approved Date:

SUMMARY: The Sr. Manager – LTC Care Management &
Nurse Navigator is responsible to provide overall supervision of all clinical
related activities including quality improvement performed by the clinical
staff. The position performs managerial
and leadership functions designed to support departmental and organizational
goals and objectives. Assists in the development, organization, direction and
maintenance of all Care Management functions for Members/Policyholders. This
position is also responsible for day to day management of the Nurse Navigator
program and for communicating all account management responsibilities with
client companies

RESPONSIBILITIES include the following. Other duties may be assigned to meet
business needs.

Supervises all care management staff, provides day-to-day
oversight in performance of the LTC operational activities. Oversees care managers in the assessment of the member’s
functional, medical and social status needs in coordinating appropriate
interventions.Determines operational requirements for the care management
functions.Assists with development and implementation of care management
protocols designed to meet the needs of CHCS contracted payors.Resolves complaints and documents resolution within established
parameters. Assists with implementation
of corrective action plan as appropriate.Analyzes and presents statistical data, findings, and trends as
required.Assesses utilization management process and assists CHCS staff to
design systems and reports to improve the effectiveness and outcomes of care
management function.Monitors client satisfaction trends and outcomes. Coordinates quality review activities.Responsible for the development and updates of utilization
management program and policy and procedure manual.Provides departmental performance and utilization data to analyze
departmental operations.Assists in recruiting, hiring, orientation and training of new
clinical services staff members.Responsible for providing supervision to LTC care management
staff, including supervisors, care managers, quality improvement and ancillary
staff. Assists with developing and implementing yearly departmental goals
and objectives.Ensures a customer-focused approach to the delivery of clinical
services through the development of and implementation of team efforts.Prepares and presents LTC reports when required.Represents the company to promote its value statement in meetings
with potential clients and payors.Responsible for discipline and discharge of clinical staff when
needed.Monitors and/or conduct departmental performance appraisals and
counsel supervisors in documenting performance issues.Assists in developing and maintaining written policies and
procedures that govern the Clinical Services/LTC Department.Assists in developing and revising department job description as
needed.Assists the supervisors and employees in the interpretation of
departmental and company policies and procedures.


Directly supervises
10 to 15 employees. Carries out supervisory responsibilities in accordance with
the organization’s policies and applicable laws. Responsibilities include
interviewing, hiring, and training employees; planning, assigning, and
directing work; appraising performance; rewarding and disciplining employees;
addressing complaints and resolving problems.


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


Must possess a
current RN license in the state of Florida. A Minimum of 5 years relevant
nursing experience in health care or human services preferred. A bachelor’s degree in nursing, health and
gerontology or a related field may be substituted for one year of experience.
Master Prepared Registered Nurse preferred.
Certification in Care Management or related specialty preferred. Three
to five years progressive managerial related experience in a health/insurance

Must have superb
written and verbal communication skills and demonstrated commitment to
collaborative practice and continues quality improvement. Detailed-oriented
with excellent organizational skills. Ability to multi-tasks. The ability to
react and adapt to changes in workflow routines. Must be proficient in
Microsoft Word, Excel and Outlook.


Ability to read,
analyze, and interpret the most complex documents. Ability to respond effectively to the most
sensitive inquiries or complaints.
Ability to write speeches and articles using original or innovative
techniques or style. Ability to make
effective and persuasive speeches and presentations on controversial or complex
topics to top management, public groups, and/or boards of directors.


Delegation Skills,
Leadership Skills, Decision-making, Initiative, Result Driven
Organizational/Planning/Organizing, Result Driven.


Ability to solve
practical problems and deal with a variety of concrete variables in situations
where only limited standardization exists.
Ability to interpret a variety of instructions furnished in written
oral, diagram, or schedule form.


Ability to calculate
figures and amounts such as discounts, interest, commissions, proportions,
percentages, area, circumference, and volume.
Ability to apply concepts of basic algebra and geometry.


Identify and
coordinate resources to solve the problem, reviewing recommendations regarding
solutions to problems, and taking action to solve the problem.


Responsible for
taking the initiative and influencing decisions within the department and/or


Knowledgeable in the
use of basic accounting principals. Capable of reconciling Budget to Actual
variances. The ability to accurately
summarize all budgets to Actual variance in financial reports form.


RN required. BSN or
CCM a plus.


The physical demands
described here are representative of those that must be met by an employee to
successfully perform the essential functions of this job. Reasonable
accommodations may be made to enable individuals with disabilities to perform
the essential functions.

While performing the
duties of this job, the employee is frequently required to sit; use hands to
finger, handle, or feel; and talk or hear.
The employee is occasionally required to stand; walk; reach with hands
and arms; climb or balance; and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or
move up to 20 pounds. Specific vision
abilities required by this job include close vision, distance vision, color
vision, and ability to adjust focus.


The work environment characteristics described here are
representative of those an employee encounters while performing the essential
functions of this job. Reasonable accommodations may be made to enable
individuals with disabilities to perform the essential functions.Office setting or work from home setting, as determined by
department management.