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The telephonic RN Case Manager position is an essential member of the multidisciplinary TrueCare 360 Program at BCBSMA. This care management position supports a Primary Nurse Model, requires enhanced communication and coaching skills as well as the ability to align with members and their families. This alignment focuses on solving member-centric problems, identifying disparities, addressing barriers to care, and developing patient goals through appropriate targeted interventions. The telephonic RN Case Manager focuses on arranging and/or coordinating services, providing resources, addressing barriers to care, and engagement in appropriate plans of care. These principles and core technology of care management are applied to members across various product lines, benefits, demographics, conditions, and programs to promote optimal health.
Key Accountabilities:
Assess and evaluate member needs and benefits by using various data tools and resources
Engage members and their families in the administration of their health plan benefits, promote medication compliance, align with healthcare professionals, as well as assist in shared decision-making
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 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
Qualifications and Skills:
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)
Education/Relevant Experience:
Minimum 3-5 years of direct patient care experience: medical-surgical unit, critical care unit, telemetry unit, sub-acute unit, skilled nursing facility, VNA, home care, and/or extended care facilities
Clinical experience in oncology, renal/nephrology and/or pediatrics is desired
Active Massachusetts Registered Nurse (RN) License to practice. Note any restrictions against a license must be disclosed and reviewed. Licensure in additional states a plus
Bachelor's degree in nursing is preferred; Master's degree is a plus
Certified Case Manager (CCM) is preferred (certification will be required after hire)
Certified Well Coach preferred (certification will be required after hire)
Ability to demonstrate proficiency with Information Technology system
Schedule of Hours:
Flexibility is required
Standard working hours are Monday through Friday anywhere from 8am-6pm (Typical shift is 8:30-4:30)
You may be required to work one evening a week, until 8pm to support our west coast membership
You may be required to work one Saturday a month to accommodate our member's needs
Flexible working hour options.
Minimum Education Requirements:
High school degree or equivalent required
Location
Quincy
Time Type
Full time
At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. We provide a flexible hybrid work model in which roles are designated as resident (on site 4-5 days/week), mobile (on site 1-3 days/week), or eworker (on site 0-3 days/month).
Blue Cross Blue Shield of Massachusetts, has a COVID-19 vaccination requirement for building entry. Your offer of employment is dependent upon either being fully vaccinated for COVID-19, or receiving an eworker exemption and/or accommodation based on a disability or sincerely held religious belief, practice, or observance by submitting a request to Human Resources.
