RN Case Manager

Blue Cross Blue Shield of Massachusetts • Quincy, MA

11d • $44 - $54 • Onsite

About The Position

Ready to help us transform healthcare? Bring your true colors to blue. The Role The Role of the RN Care Manager is responsible for facilitating care for members and families of members who may have rising health risks or complex healthcare needs, to promote optimal health. This position is self-directed and works independently and collaboratively to facilitate care based on the principles of care management. Facilitation is focused on assessing needs, identifying health care disparities, social determinants of health, and any barriers to care.

Requirements

• Active MA RN License is required; additional states is a plus! Note: any restrictions against a license must be disclosed and reviewed.
• Minimum of 3-5 years direct patient care experience, (home care, hospital, or extended care facility)
• Clinical expertise in disease management, critical illnesses, and/or complex chronic conditions is required
• Ability to adapt and be flexible to change as priorities within this environment change constantly
• Willingness to learn new skills from both a business and clinical perspective
• Strong teamwork and communication skills as well as ability to be self-directive
• Ability to analyze information to construct effective solutions
• Execution and results (ability to set goals, follow processes, meet deadlines, and deliver expected outcomes with appropriate sense of urgency)
• Cultural competence (demonstration of awareness, attitude, knowledge, and skills to work effectively with a culturally and demographically diverse population)
• Clinical assessment (ability to interpret, evaluate, and clearly document complex medical information using a directive and focused approach in order to identify relevant and actionable conditions, circumstances, and behaviors)
• Care planning (ability to identify and clearly document member-driven, specific, measurable activities that address actionable conditions, circumstances, and behaviors in order to improve health outcomes and cost-effectiveness of services)
• Member collaboration and engagement (ability to secure and maintain the motivation, participation, and collaboration of all relevant parties in a purposeful plan to improve health outcomes and cost-effectiveness of service delivery)
• Must be available to work out of the Quincy, MA office Monday - Friday
• Knowledge of managed care plans and health insurance experience a plus
• High school degree or equivalent required unless otherwise noted above

Nice To Haves

• Triage experience, highly desired!
• Bachelor’s degree in Nursing is preferred, masters a plus
• Certified Case Manager (CCM) is preferred, required for some roles

Responsibilities

• Assess and evaluate member or family support needs by using various data tools and resources
• Assist members and their families in the administration of their health plan benefits, promote medication compliance, coordinate care with treatment providers, PCP’s and other providers including VNA providers
• Assist the member in shared decision-making and goal setting
• Collaborate within a team of professionals (supervisors, managers, account representatives, member service associates, and physicians) to provide care coordination appropriate for members
• Interpret and apply case management criteria, processes, policies, and applicable regulatory standards
• Interact with treatment providers, PCPs, and physicians as needed to support the plan of care
• Monitor for clinical quality concerns and refers appropriately
• Provides telephone triage and crisis intervention when situation warrants, collaborating with utilization management peers when appropriate
• Will need to understand regulatory requirements for designated for Medicare Advantage

Benefits

• We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED