Blue Cross Blue Shield Of Massachusetts
RNCaseManager
“RN Case Manager at Blue Cross Blue Shield Of Massachusetts. Skills: Case Management, Clinical Knowledge, Communication Skills. Facilitate care for members. Assess member needs”
What You'll Achieve.
Promote optimal health; Promote optimal member outcomes; Support optimized health outcomes; Achieve optimal outcomes for members; Deliver expected outcomes
Industry & Context.
Ability to assess, analyze, draw conclusions, and construct effective solutions
What They're Looking For.
Must Have
Active licensure in Massachusetts is required, appropriate to position (RN, LMHC, LICSW, LCSW), High school degree or equivalent required
Nice to Have
Case Management experience preferred, Certifications such as Case Management (CCM), certified diabetic educator, and Wellcoach certification a plus, Licensure in additional states a plus, For Registered Nurses Only: A Bachelor’s degree in nursing (BSN) is preferred
What You'll Do.
Facilitate care for members
Identify health care disparities
Identify social determinants of health
Identify barriers to care
Engage members in plans of care
Coordinate care and services
Provide members with education
Provide members with resources
Continually assess member needs
Evaluate member needs
Promote member compliance
Encourage shared decision-making
Set appropriate goals
Interpret case management criteria
Apply case management processes
Apply case management policies
Apply regulatory standards
Create care management plans
Follow care management plans
Document care management plans
Review medication list
Educate members with complex pharmacy needs
Counsel on side effects
Counsel on mitigation strategies
Connect and engage members
Maintain member engagement
Support seamless care transitions
Support optimized health outcomes
Interact with treatment providers
Gather clinical information
Monitor clinical quality concerns
Make referrals appropriately
Identify quality of care issues
Escalate quality of care issues
Understand member insurance products
Understand member benefits
Identify cases for medical rounds
Follow up with providers
Support positive workplace environment
Collaborate with team
Share clinical knowledge
Share clinical skills
Other clinical duties as assigned
How You'll Work.
Team & Collaboration
Works independently and collaboratively; Collaborate within a team of professionals; Collaborate as a member of a team; Collaborate and share clinical knowledge and skills
Communication Scope
Excellent written and verbal communication skills
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