Case Manager, RN (Multiple Openings!)

Excellus BCBS•De Witt, AR

1d•$62,400 - $117,622

About The Position

Conducts case management program activities in accordance with departmental and corporate policies and applicable NYS Department of Health, CMS, Federal Employee Program, and NCQA standards. Uses a systematic approach to identify eligible members and assess opportunities to educate, support, coach, coordinate care, and review treatment options in collaboration with providers and community-based resources. Participates in a cross-functional, multidisciplinary team to implement member-centered interventions and support optimal, cost-effective health outcomes. Collaborates with the interdisciplinary care team to develop comprehensive care plans addressing members’ needs and health goals and mitigating health care cost drivers. The position has three classification levels with increasing independence, complexity, leadership, and responsibility. Level I manages physical health clinical programs and carries out the case management process, including identification, assessment, education, care planning, interventions, reassessment, case review, and closure. Level II handles all member clinical condition management programs, more complex assignments and/or larger caseloads, and provides mentoring. Level III provides subject-matter expertise and escalation support, improves processes and documentation, mentors staff, and may back up the Supervisor/Manager. The position requires an associate degree and an active NYS RN, Registered Dietitian, or Physical Therapist license. A bachelor’s degree is preferred. At least three years of clinical experience is required. The role requires proficiency with Microsoft Office, strong communication and organizational skills, and the ability to work independently. Travel and long hours on a computer may be required, and flexible hours may be needed for member discussions. Remote work may be possible on a case-by-case basis. Compensation ranges are Level I: $62,400–$96,081; Level II: $62,400–$106,929; and Level III: $65,346–$117,622. Actual salary depends on factors including budget, experience, knowledge, skills, education, and internal equity. The total rewards package may include group health and/or dental insurance, a retirement plan, wellness program, paid time away from work, and paid holidays.

Requirements

Associate degree required; bachelor’s degree preferred.
Active New York State RN, Registered Dietitian, or Physical Therapist licensure required.
At least three years of clinical experience required.
Proficiency with Microsoft Office Suite.
Strong written and verbal communication skills.
Ability to multitask and balance priorities.
Ability to work independently on a daily basis.
Ability to deliver efficient, effective, and seamless care to members.
For employees aligned to the Federal Employee Program line of business, Case Management Certification is required within two years of hire and/or moving into the role.
For employees aligned only to the Hospital to Home program, an active NYS RN license with three years of behavioral health experience, or LMSW, LCSW, or LMHC, is required.
Level II: At least two years in a case management position; ability to escalate issues to management; proficiency with related technology and documentation; and consistent achievement of performance metrics.
Level III: At least five years in a current case management position or similar subject-matter expert role; broad knowledge of multiple areas such as Utilization Management and Case Management and supporting systems; expertise handling complex assignments and issues; ability to lead new staff training; and demonstrated presentation skills.

Nice To Haves

Bachelor’s degree.
Case Management experience for Level I applicants.
Experience interpreting managed care benefit plans and strong knowledge of Medicare and Medicaid government program contracts and benefits.
Case Management Certification for Level II.
Experience or expertise across multiple functional areas, including Utilization Management and Case Management, for Level III.

Responsibilities

Conduct case management activities in accordance with departmental, corporate, state, federal, and accreditation requirements.
Screen referred or identified members and use case management criteria and clinical judgment to determine eligibility and appropriateness for services.
Initiate case management and open appropriate cases in a timely manner, using motivational interviewing to explain the program and support member engagement.
Implement the case management process, including member assessment, education, care planning, interventions, reassessment, case reviews, and case closure.
Collaborate with members, caregivers, physicians, and other providers to assess needs, establish goals, develop interdisciplinary care plans, coordinate services, and modify plans as necessary.
Assess member and caregiver knowledge of illnesses and provide appropriate education to address knowledge gaps.
Provide members with resources and assistance for managing health across the continuum of care; maintain information on community resources and act as a liaison between providers and those resources.
Coordinate with interdisciplinary teams and other functions, including Utilization Management, Quality, Behavioral Health, Pharmacy, Registered Dietitians, and Respiratory Therapists.
Maintain confidentiality and follow corporate and departmental information management and privacy policies.
Participate in continuing education and promote health plan programs, preventive health, self-management tools, and digital health programs.
Collaborate with other case managers and clinical disciplines to support continuity and coordination of care.
May work with internal and external stakeholders on value-based payment programs.
Maintain professional integrity, support company values, meet attendance expectations, and perform other duties as assigned.
At Level II, suggest and participate in process improvements, mentor junior staff, meet performance metrics, manage more complex assignments or larger caseloads, and model leadership.
At Level III, identify and evaluate process improvements, assist with policies and manuals, develop performance improvement processes, resolve escalations, mentor and guide staff, and provide backup for the Supervisor/Manager.
At Level III, support staff orientation and training, liaise with internal departments as needed, help ensure regulatory compliance, and take responsibility for department quality, productivity, utilization performance, and educational needs.