Manager of Care Management

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

3d•$93,600 - $140,400

About The Position

The Manager of Care Management manages the department’s daily operations and the development, implementation, and maintenance of its policies, procedures, and programs. The role ensures case management services align with industry standards, best practices, and company strategy, and monitors industry trends to keep programs innovative and aligned with company goals. The manager oversees case management programs, supports collaboration between utilization review and case management, evaluates program effectiveness, recommends improvements, monitors expenses against budget targets, and ensures compliance with applicable regulatory guidelines. The role also assists with contract development and implementation and provides direction, technical guidance, goal setting, work evaluation, and performance reviews for staff. The position requires residence within a commutable distance of Rhode Island, Massachusetts, or Connecticut. BCBSRI describes in-office, hybrid, and remote schedules, with remote eligibility subject to state and HR 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, and 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 decision-making skills.
Strong organization and time-management skills.
Proficiency with Microsoft Suite products, including Word, Excel, and PowerPoint.
Ability to effectively interact 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 Case Management Certification (CCM) within three years of tenure in the position.

Responsibilities

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