Supervisor, Clinical Ops

NJM Insurance Group

Supervisor managing clinical operations for Horizon Blue Cross Blue Shield. Responsibilities include managing teams and improving healthcare quality for members.

Posted 5/6/2026full-timeHopewell • New Jersey • 🇺🇸 United StatesJuniorMid-Level💰 $87,300 - $119,070 per yearWebsite

About the role

Key responsibilities & impact

Manages, analyzes and coordinates the daily activities of the unit to ensure departmental productive goals are met with regards to quality timeliness, accuracy and consistency of medical decisions
Ensures staff meets all regulatory requirements and comprehends and complies with best practices, professional standards, internal policies and procedures
Conducts continuous evaluation of workflows and seeks to improve processes that impact the department
Coordinates data collection, reviews compliance reporting and identifies opportunities for improvements
Identifies and implements cost saving/revenue generating opportunities
Serves as key liaison between Medical Directors, Management leadership, and staff
Develops key performance indicators to evaluate level of service for internal and external customers
Acts as a subject matter expert for difficult and complex matters
Represents the Plan with external customers, providers and agencies
Represents the department on internal committees and participates in special projects
Assists Manager in coordinating regulatory, quality and accreditation activities
Performs other duties as assigned by management
Creates and champions an atmosphere within the team, which fosters open communication, teamwork, ownership, and a collaborative cross-departmental environment to implement, optimize and share continuous improvement processes
Manages, directs, and develops staff by providing feedback and coaching
Administers performance and salary reviews for staff
Assists in preparing and monitoring the budget to ensure administrative cost objectives are met

Requirements

What you’ll need

Requires a Nursing degree or a Masters in a Behavioral health related field or a Bachelors in a health related field
Requires a minimum of two years' full time acute healthcare/direct clinical care experience to the consumer
Requires a minimum of one year direct supervisory experience or demonstrated supervisory experience leading teams in a matrix management environment
Prefer certification as a case manager
Prefer minimum of three years’ experience as a case manager
Requires minimum of 12 months experience in a managed care setting or the health insurance industry
Active Unrestricted NJ LCSW, LMFT, LPC, or RN/PT License Required for Medicaid Case Management
Requires knowledge of Utilization Management (UM) and managed care principles
Requires knowledge of the Case Management/Disease Management Standards of Practice
Requires knowledge of health care systems and medical documentation
Requires knowledge of State Mandates and Regulations
Requires knowledge of regulatory bodies and their processes
Requires knowledge of NCQA accreditation standards
Requires knowledge of community health resources
Requires the ability to express thought clearly and concisely both orally and written
Requires the ability to obtain the skills possessed by the team members and system technical competence
Requires the ability to effectively lead team members in diversified tasks
Requires excellent organizational skills
Requires excellent presentation skills
Requires the ability to think analytically and to report findings in an accurate manner
Must be proficient in the use of personal computers and supporting software in a Windows based environment including MS Office products (Word, Excel, PowerPoint) and Outlook; should be knowledgeable in the use of intranet and internet applications.

Benefits

Comp & perks

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Nursing degreeMasters in Behavioral healthBachelors in health related fieldAcute healthcare experienceSupervisory experienceCase management certificationUtilization Management (UM)Managed care principlesMedical documentationNCQA accreditation standards

Soft Skills

LeadershipCommunicationOrganizational skillsAnalytical thinkingTeamworkCoachingCollaborationPresentation skillsFeedbackContinuous improvement

Certifications

Active Unrestricted NJ LCSWLMFTLPCRN LicensePT LicenseCase manager certification