Blue Cross Blue Shield Of Massachusetts
Healthcare
RNCaseManager
“RN Case Manager at Blue Cross Blue Shield Of Massachusetts. Skills: facilitating care for members, assessing needs, identifying health care disparities, social determinants of health, barriers to care, coordinate care and services, provide members with education and resources, Promote member compliance with treatment plan, encourage shared decision-making, set appropriate goals, Interpret and apply case management criteria, processes, policies, and regulatory standards, document comprehensive ca”
What You'll Achieve.
promote optimal health; promote optimal member outcomes; support seamless care transitions and optimized health outcomes
Industry & Context.
Any restrictions against a license must be disclosed and reviewed.
What They're Looking For.
Must Have
Active licensure in Massachusetts is required, appropriate to position (RN/PT)
Nice to Have
Utilization Management experience, Licensure in additional states a plus
What You'll Do.
Facilitating care for members and families of members who may have rising health risks or complex healthcare needs
to promote optimal health.
identifying health care disparities
social determinants of health
and any barriers to care.
Engage members in appropriate plans of care
coordinate care and services as appropriate
communicate effectively and provide members with education and resources as needed.
Promote member compliance with treatment plan
encourage shared decision-making
and set appropriate goals to promote optimal member outcomes.
Interpret and apply case management criteria
and regulatory standards to create
follow and appropriately document comprehensive care management plans.
Review medication list and educate members with complex pharmacy needs
and counsel on side effects and mitigation strategies for specific treatment protocols.
and maintain member engagement to support seamless care transitions and optimized health outcomes.
Interact with treatment providers
and facilities as needed to gather clinical information to support the plan of care.
Monitor clinical quality concerns
make referrals appropriately
identify and escalate quality of care issues.
How You'll Work.
Team & Collaboration
works independently and collaboratively; part of a highly dedicated and motivated team of professionals, including medical and behavioral health care managers, dieticians, pharmacist, clinicians, medical directors and more, who collaborate to facilitate care.; able to collaborate as a member of a team
Communication Scope
communicate effectively
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