Responsible for understanding the Children’s Behavioral Service Delivery System and access to that system. Work closely with Member, Member’s family, and providers to determine appropriate level of care to meet treatment needs. Clinical Care Managers are responsible to ensure that treatment delivered is appropriately utilized and meets the Member’s needs in the least restrictive, least intrusive manner possible. Will maintain caseload. Non-Business hour On-call responsibilities as scheduled/needed.

Masters Degree in Social Work, Psychology, Nursing or related field, plus Professional License/Certification required. Excellent communication skills (verbal and written), and the ability to handle difficult situations in a professional manner required. Minimum of three years post-graduate clinical experience or equivalent combination of education and clinically related work experience. Minimum of one-year experience in Behavioral Health Rehabilitative Service Delivery System. Experience with CASSP. Knowledge base in Medicaid, Medicare and Commercial Managed Care Systems, as well as, CAC and Bilingual strongly preferred.

 

 

 

 

Description of Duties:Member Services Specialists are responsible for the intake processes of CBHNP. They are the first point of contact for Members accessing the company. This position is responsible for answering the telephone and explaining the operation of CBHNP to Members when they call; Completing intake information regarding the member; Explaining procedures for accessing services to Members; Coordinating/Interfacing with the Medical Assistance Transportation Program (MATP), as necessary, to assist Members in securing transportation to scheduled appointments; Completing bed searches, as necessary, for IP and SA bed requests; Addressing Member complaints through the initialization of the CBHNP Grievance and Complaint process; Explaining a Member’s rights as requested; Providing additional resources to the Member such as a Member Handbook and list of in-plan providers from the Member’s geographic region and completing data entry of requests and authorizations.

Qualifications Required:Bachelor’s degree required. Excellent written and verbal communication skills with the ability to respond sensitively to members requests required. Previous customer service and data entry experience required preferably within a call center. At least one year of experience in mental health and/or human services required; or equivalent background and experience that would translate well into this position. Experience with PC’s in a windows based environment required.

 

 

Description of Duties:Member Services Specialists, specifically for Highmark, are responsible for responding to Highmark Member, family member and provider inquiries and requests for services by providing information and initiating intake processes for certain levels of care. They are also responsible for maintaining solid Member, family member and provider relationships by responding to requests, questions and concerns with accuracy and professionalism in a prompt, courteous manner. They are the first point of contact for those accessing Highmark outside of business hours for Behavioral Health Services.

Qualifications Required:Associates degree in Human Service field preferred; will consider high school diploma with good customer service experience/background. 1 year prior experience in behavioral health/managed care/human services required or other background and experience that would translate well into this position. 1-3 years customer service and data entry experience required, preferably in call center environment. Previous telephone experience, preferably in call center environment. Previous experience in an office setting and/or doctor’s office/hospital preferred.

 

 

Description of Duties:Member Services Specialists are responsible for the intake processes of CBHNP. They are the first point of contact for Members accessing the company. This position is responsible for answering the telephone and explaining the operation of CBHNP to Members when they call; Completing intake information regarding the member; Explaining procedures for accessing services to Members; Coordinating/Interfacing with the Medical Assistance Transportation Program (MATP), as necessary, to assist Members in securing transportation to scheduled appointments; Completing bed searches, as necessary, for IP and SA bed requests; Addressing Member complaints through the initialization of the CBHNP Grievance and Complaint process; Explaining a Member’s rights as requested; Providing additional resources to the Member such as a Member Handbook and list of in-plan providers from the Member’s geographic region and completing data entry of requests and authorizations.

Qualifications Required:Bachelor’s degree required. Excellent written and verbal communication skills with the ability to respond sensitively to members requests required. Previous customer service and data entry experience required preferably within a call center. At least one year of experience in mental health and/or human services required; or equivalent background and experience that would translate well into this position. Experience with PC’s in a windows based environment required.

 

 

Description of Duties:Responsible for understanding the Children’s Behavioral Service Delivery System and access to that system. Work closely with Member, Member’s family, and providers to determine appropriate level of care to meet treatment needs. Clinical Care Managers are responsible to ensure that treatment delivered is appropriately utilized and meets the Member’s needs in the least restrictive, least intrusive manner possible. Will maintain caseload. Non-Business hour On-call responsibilities as scheduled/needed.

Qualifications Required:Masters Degree in Social Work, Psychology, Nursing or related field, plus Professional License/Certification required. Excellent communication skills (verbal and written), and the ability to handle difficult situations in a professional manner required. Minimum of three years post-graduate clinical experience or equivalent combination of education and clinically related work experience. Minimum of one-year experience in Behavioral Health Rehabilitative Service Delivery System. Experience with CASSP. Knowledge base in Medicaid, Medicare and Commercial Managed Care Systems, as well as, CAC and Bilingual strongly preferred.

 

 

Description of Duties:Under the direction of the Manager, Application Development and in cooperation with other IT Staff, responsible for designing, developing, distributing and maintaining custom software applications in a multi-user, networked environment. Participate in the design and implementation of related databases and associated hardware and software. Maintain advanced knowledge of Visual Basic. Net 2005. Maintain working level knowledge of SQL Server 2000 and 2005.

Qualifications Required:Bachelor’s degree in Computer Science or a related field and 1 year experience in a similar role OR an equivalent combination of education and work experience; 1-2 years experience VB.Net and object oriented programming techniques required; Intermediate encoding and object oriented programming skills with Microsoft supported languages, preferably VB.net; Intermediate database development skills, preferably with SQL; Excellent communication skills; Strong time management and organizational skills.; Ability to work as a part of a team; Analytical skills necessary in order to recommend design of company-wide data processing systems as well as departmental data processing systems, and assist in developing departmental policies, procedures, and budgets;

 

 

Description of Duties:Responsible for understanding the Children’s Behavioral Service Delivery System and access to that system. Work closely with Member, Member’s family, and providers to determine appropriate level of care to meet treatment needs. Clinical Care Managers are responsible to ensure that treatment delivered is appropriately utilized and meets the Member’s needs in the least restrictive, least intrusive manner possible. Will maintain caseload. Non-Business hour On-call responsibilities as scheduled/needed.

Qualifications Required:Masters Degree in Social Work, Psychology, Nursing or related field, plus Professional License/Certification required. Excellent communication skills (verbal and written), and the ability to handle difficult situations in a professional manner required. Minimum of three years post-graduate clinical experience or equivalent combination of education and clinically related work experience. Minimum of one-year experience in Behavioral Health Rehabilitative Service Delivery System. Experience with CASSP. Knowledge base in Medicaid, Medicare and Commercial Managed Care Systems, as well as, CAC and Bilingual strongly preferred.

 

 

Description of Duties:This position is responsible to design and build data processes including ETL (extract, transform & load) as required to meet data integrity standards and contractual obligations to business partners both internal and external. Duties will include support of production SQL databases and data warehouses and requires advanced expertise in all Microsoft SQL Server functions and tools.

Qualifications Required:Bachelor’s degree in Computer Science or a related field and 3-5 years experience with SQL programming OR an equivalent combination of education, certification and work experience; 3-5 years experience with MS SQL programming including use of advanced SQL queries, stored procedures, triggers, scripts, cursors, indexes, DTS, data modeling, views and ETL processes; Expert knowledge of SQL required to design and implement database objects (tables, views, queries, indexes, stored procedures, imports, exports, etc.); Understanding of Data Transformation Services in order to execute and maintain existing packages and assist with development of new packages; Understanding of database best practices (data normalization, relational design, etc.) in order to assist with application development; Working knowledge of routine database maintenance functions, such as attaching/detaching databases, backing up and restoring databases and scheduling/executing database jobs and DTS packages.

Excellent communication skills: Verbally and in writing with all internal and external customers. This is especially essential and necessary when interacting with end users in order to provide ad-hoc reports or information; Strong time management and organizational skills; Ability to work as a part of a team and independently; Analytical skills necessary in order to assist with designing data processing systems and develop required reports; Creative problem solving skills

 

 

Description of Duties:Under the direction of the Manager, Database Administration, this position is responsible for the configuration, administration and maintenance of SQL Server databases; performing routine data maintenance and other related duties to ensure data integrity, improve automation of systems, support continuous operations and application development. Duties may also include programming and development of various tools required to improve processes.

Qualifications Required:Bachelor’s degree in Computer Science or a related field and 2 years experience in a similar role OR an equivalent combination of education and work experience (4-5 years experience with MS SQL and database administration if not degreed).
- Approximately 2-3 years progressively more responsible related work experience, necessary in order to gain understanding of database operations, data analysis and systems design.
- Advanced knowledge of SQL required to design and implement database objects (tables, views, queries, indexes, stored procedures, etc.).
- Understanding of SQL Server Integration Services (SSIS) in order to execute and maintain existing packages and assist with development of new packages.
- Familiarity with database best practices (data normalization, relational design, etc.) in order to assist with application development.
- Working knowledge of routine database maintenance functions, such as attaching/detaching databases, backing up and restoring databases and scheduling/executing database jobs and SSIS packages.
- Excellent communication skills: Verbally and in writing with all internal and external customers. This is especially essential and necessary when interacting with end users in order to provide ad-hoc reports or information.
- Strong time management and organizational skills. Ability to work as a part of a team.
- Interpersonal skills necessary in order to discuss data processing projects effectively and recommend services and solutions to a variety of personnel.
- Analytical skills necessary in order to assist with designing data processing systems.
- Ability to be subject matter expert in Structured Query Language (SQL).

 

 

Description of Duties:The QI Specialist is responsible for performing independent functions related to quality management and improvement in compliance with NCQA accreditation standards, as well as, understanding the Children and Adult Service Delivery System and access to the system. This position will attend all Level I, Level II, and Fair Hearing Grievances as the Clinical Representative to the Complaints and Grievance unit. This position serves as a key liaison with Clinical Care Managers and Member Services Specialist staff who is often the initial recipients of complaints, grievances and other quality concerns. They are also a key liaison with providers, county staff, and other parties involved in evaluating the quality of clinical care and improvement of clinical and non-clinical practices. Moderate travel required.

Qualifications Required:Graduate degree from an accredited educational program in Social Work, Clinical/Counseling, or Psychology; License and/or professional certification preferred but not required. Minimum of two years post graduate clinical experience and one-year experience working with a managed care system. Previous Quality Improvement experience required. Internal and external auditing strongly preferred. Experience with CASSP preferred. Experience with and/or knowledge of Levels of Care and services provided to Members. Previous C&G experience strongly preferred. Knowledge in Medicaid, Medicare, and Commercial managed care systems. Strong time management, project management, and organization skills. Strong written and oral communication skills. Strong presentation skills. Strong analytical skills. Ability to handle difficult situations and work under pressure. Ability to use PC’s in a Windows based environment with the ability to work in complex Excel spreadsheets required. Demonstrates knowledge of prescribed and established clinical procedures and practices.

 

 

Description of Duties: The Field Care Manager (“FCM”) is responsible for understanding the Behavioral Health Service Delivery System, specific to the child and adolescent population, and access to that system. Clarify, educate, and collaborate with Member, Member’s family, providers, and other child serving entities in assessing behavioral health needs and appropriate level of care. Field Care Manager will work closely with the regional office in establishing protocols in attending Member treatment team meetings and will also coordinate with the corporate office / North Central Care Management Unit on case conferences, medical necessity determinations, and clinical documentation. Overall, this position is responsible to ensure that treatment delivered is appropriately utilized and meets the Member’s needs in the least restrictive, least intrusive manner possible while cognizant of regional practices and building partnerships.

Qualifications Required: Graduate degree from an accredited educational program in Social Work, Clinical/Counseling Psychology, or Nursing; professional license/certification preferred. Minimum of two years post-graduate clinical experience or equivalent combination of education and clinically related work experience; Minimum of two-year experience in Behavioral Health Service Delivery System, specifically Behavioral Health Rehabilitation Services in a Master’s Level position; Minimum of one-year experience working with a managed care system preferred; Proven leadership experience strongly preferred; Knowledge base in Medicaid Managed Care Systems (preferably HealthChoices). Strong written and oral communication skills with ability to work independently; Strong presentation skills with ability to lead team meetings; Ability to perform multiple tasks; Excellent interpersonal and organizational skills; Strong documentation skills; Ability to work effectively in a team environment; PC skills and experience utilizing Microsoft Office, Outlook, Excel, Power Point.

 

 

Description of Duties: Responsible for understanding the Children’s System of Care and access to services. Work closely with Member, Member’s family, and providers to determine appropriate level of care to meet treatment needs. Care Coordinators are responsible to ensure that treatment delivered is appropriately utilized and meets the Member’s needs in the least restrictive, least intrusive manner possible. Care Coordinators may be assigned to a specific area/specialty based on background and/or acquired training (i.e. DYFS: DYFS Care coordinator will work closely with the DYFS system and youth involved in the same).

Qualifications Required: Graduate degree from an accredited educational program in Social Work, Clinical/Counseling Psychology; RN or PhD. Must be licensed to practice in the state of NJ (New Jersey Licensure required such as an LSW). The following are strongly preferred: RN, LCSW, LMFT, LPC Minimum of three years post-graduate clinical experience or equivalent combination of education and clinically related work experience; Minimum of one-year experience working with a managed care system; Minimum of one-year experience in Children’s System of Care; Knowledge base in Public Medicaid and Children’s System of Care; Previous experience with first hand knowledge and/or coordinating work with the DYFS strongly preferred. (DYFS Care Coordinator required); Strong written and oral communication skills; Ability to perform multiple tasks; Excellent interpersonal personnel and organizational skills; Ability to work effectively in a team environment; PC skills and experience utilizing Microsoft Office, Outlook, Excel.

 

 

Description of Duties: The Supervisor of Data Analysis oversees, manages, and directs the Data Analysts within the QI department. Overall responsibility for the reporting, analyzing and tracking of trends in utilization, access, cost, quality, outcomes and membership. Responsible for assuring the accuracy and validity of data, while interpreting results into recommendations to increase the efficiency and effectiveness of the CSA and System of Care. Develop and/or assist in the logical design of a data mart. Oversee and generate standard and ad hoc reports to help customers better understand costs and analyze clinical data to discover trends and patterns. Manipulate, search and analyze large databases using SQL, VB, Access and Excel technologies. This leadership role requires innovative and creative thinking with strong planning and organizational skills. Meet assigned deadlines for completing data analysis projects. Represents PerformCare on selected committees and workgroups.

Qualifications Required: Bachelor’s Degree in Computer Science, Information Technology or Information Sciences required. Master’s preferred; Minimum 7 to 10 years experience in business and data analysis, healthcare or managed care field experience preferred. Strong PC skills (including Excel, Access, SQL), other reporting database management systems. Minimum 2-4 years supervisory experience. Ability to effectively communicate verbally and in writing to various levels of management. Other: Strong customer focus and excellent interpersonal skills. Strong analytical skills with ability to analyze reporting aberrations and provide explanations for variances and changes. Strong research, testing and validation skills with accurate results Strong working knowledge of complex statistical concepts. Ability to manipulate files from and to a variety of formats in order to meet user needs. Strong planning, time management, problem-solving, analytical, listening, logical and lateral thinking skills. Ability to work independently, lead a team and pursue several projects at the same time.