RN Case Manager

Blue Cross Blue Shield of Massachusetts•Hingham, MA

13d•$44 - $54

About The Position

The Clinical Care Manager facilitates 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 works independently and collaboratively, applying care management principles to assess needs and identify healthcare disparities, social determinants of health, and 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, and medical directors. The role engages members in care plans, coordinates services, provides education and resources, supports treatment-plan adherence and shared decision-making, and helps members set appropriate health goals. It also involves applying case management criteria and regulatory standards, reviewing medication lists, coordinating with providers and facilities, monitoring quality concerns, and supporting effective care transitions. This is a full-time position located in Hingham. The hourly range is $44.12–$53.93, and the role is eligible for variable pay. The company offers eligible employees paid time off, medical, dental, and vision insurance, a 401(k), and well-being benefits.

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; any license restrictions must be disclosed and reviewed.
Ability to identify and document member-driven, specific, measurable activities that address actionable behaviors and goals.
Ability to work independently and collaboratively; self-directed, adaptive, and flexible to change.
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, unless otherwise noted above.

Nice To Haves

Utilization Management experience is preferred.
Licensure in additional states is a plus.

Responsibilities

Engage members in appropriate plans of care, coordinate care and services, communicate effectively, and provide education and resources as needed.
Promote adherence to treatment plans, encourage shared decision-making, and set appropriate goals to support optimal member outcomes.
Interpret and apply case management criteria, processes, policies, and regulatory standards to create, follow, and 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, support ongoing engagement, and facilitate seamless care transitions and optimized health outcomes.
Interact with treatment providers, primary care providers, physicians, therapists, and facilities to gather clinical information supporting members’ plans 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.