RN Case Manager (Maternity)

Blue Cross Blue Shield of Massachusetts•Hingham, MA

20h•$44 - $54

About The Position

The Federal Employee Program Clinical Care Manager is responsible for facilitating care for members and their families who may have rising health risks or complex healthcare needs, with the goal of promoting optimal health. The position is self-directed and involves working independently and collaboratively to facilitate care based on care management principles. This includes assessing needs, identifying healthcare disparities and social determinants of health, and addressing barriers to care. The Clinical Care Manager is part of a dedicated, multidisciplinary team that includes medical and behavioral health care managers, dieticians, pharmacists, clinicians, medical directors, and others who collaborate to facilitate care.

Requirements

3–5 years of relevant experience in a variety of appropriate clinical healthcare settings, such as inpatient, outpatient, or differing levels of care.
Active Massachusetts licensure appropriate to the position (RN/PT) is required.
Ability to identify and document member-driven, specific, measurable activities that address actionable behaviors and goals.
Self-directed and independent, adaptable and flexible to change, and able to collaborate as a team member.
Proficiency with multiple IT systems.
Awareness, attitude, knowledge, and skills needed to work effectively with a culturally and demographically diverse population.
High school degree or equivalent required unless otherwise noted above.
Restrictions against a license must be disclosed and reviewed.

Nice To Haves

Maternal health experience preferred.
Licensure in additional states is a plus.

Responsibilities

Engage members in appropriate care plans, coordinate care and services, communicate effectively, and provide education and resources as needed.
Promote member compliance with treatment plans, encourage shared decision-making, and set appropriate goals to support optimal outcomes.
Interpret and apply case management criteria, processes, policies, and regulatory standards to create, follow, and appropriately document comprehensive care management plans.
Review medication lists and educate members with complex pharmacy needs, including counseling on side effects and mitigation strategies for specific treatment protocols.
Connect with members, engage them, and maintain engagement to support seamless care transitions and optimized health outcomes.
Interact with treatment providers, primary care providers, physicians, therapists, and facilities to gather clinical information supporting the plan of care.
Monitor clinical quality concerns, make appropriate referrals, and identify and escalate quality-of-care issues.
Understand member insurance products and benefits, as well as regulatory and NCQA requirements.