Manager of Care Management

Blue Cross & Blue Shield of Rhode Island•Providence, RI

About The Position

Manage the daily operations of the Care Management department and the development, implementation, and maintenance of departmental policies, procedures, and programs. Ensure case management services align with industry standards, best practices, and company strategy. Monitor industry trends so programs remain innovative and support company goals. The role also oversees staff performance and development, departmental expenses, regulatory compliance, and contract development and implementation. The position is based at BCBSRI, headquartered in downtown Providence, and requires residence within a commutable distance of Rhode Island, Massachusetts, or Connecticut. Depending on the role, BCBSRI offers in-office schedules (onsite five days per week), hybrid schedules (onsite two to four days per week), or remote schedules (onsite zero to one day per week). Remote work is permitted in specified states, subject to Human Resources approval.

Requirements

Bachelor’s degree in Nursing or a related field, or an equivalent combination of education and experience, with an active and unrestricted RN license issued by a state participating in the Nurse Licensure Compact (NLC).
Five to seven years of experience in utilization review, case management, and/or disease management.
Up to five years of clinical nursing or other related applicable experience.
Three to five years of management experience or experience leading a team.
Knowledge of managed benefits strategies, utilization review techniques, health care financing and delivery, program development, care management, quality management, and health care administration.
Knowledge of evidence-based clinical practice.
Ability to coach and motivate to maximize performance.
Ability to effectively communicate goals and business objectives to employees.
Strong and effective decision-making skills.
Strong organization and time-management skills.
Proficiency with Microsoft Suite products, including Word, Excel, and PowerPoint.
Ability to interact effectively with all levels of the organization.
Ability to delegate work effectively and manage project tasks.
Excellent verbal and written communication skills, including the ability to convey complex or technical information effectively.
Must reside within a commutable distance of Rhode Island, Massachusetts, or Connecticut.

Nice To Haves

Possession and maintenance of a Case Management Certification (CCM) within three years of tenure in the position.

Responsibilities

Manage case management programs to ensure services align with company goals.
Develop programs that maximize collaboration between utilization management and case management to achieve departmental objectives.
Evaluate programs for effectiveness and determine whether they should be modified or eliminated.
Recommend improvements to case management programs to the department’s leadership team.
Monitor department expenses regularly to ensure budget targets are met.
Ensure departmental compliance with applicable regulatory guidelines, including NCQA, DOH, CMS, URAC, HIPAA, State of Rhode Island Workers’ Compensation Protocol, and DOL requirements.
Assist with contract development and implementation to ensure contracts reflect medical management initiatives, processes, and regulatory requirements.
Provide direction, guidance, and technical guidance to staff.
Set goals, review and evaluate work, and prepare performance reviews.
Perform other duties as assigned.

Benefits

Flexible work arrangements, including remote and hybrid opportunities, depending on role.
Paid time off.
Tuition reimbursement.
Student-loan repayment assistance.
Health insurance.
Dental insurance.
Vision insurance.
Programs supporting mental health and well-being.
Competitive pay.
Bonuses and investment plans.
Additional paid time to volunteer.
Commitment to employee growth and development.