Manager Case Management

Please email HR_Talent_AcquisitionTeam@bcbsri.org if you are a candidate seeking a reasonable accommodation for the application and/or interview process.

Location: Hybrid

Compensation: $90,500 - $135,700

Jump into the new world of health insurance:

At Blue Cross & Blue Shield of Rhode Island (BCBSRI), our business is healthcare. But our focus is on improving lives. Be part of a team that is large enough to make a difference but small enough to be innovative. Work in a rapidly changing field. Take a chance to be creative. Move outside the status quo. Shape new ideas with the power of a national brand behind you.

Join others who know diversity is strength:

We appreciate and celebrate everything that makes us unique: age, national origin, citizenship status, perspectives, experiences, physical or mental disability, military status, race, ethnicity, religion, gender, sexual orientation, gender identity and/or expression. Our diversity strengthens us as an organization and helps us better serve an increasingly diverse Rhode Island population.

Why this job matters:

Responsible for managing daily operations and effectiveness of dual Medicare/Medicaid covered member care coordination. Teams consists of nurse care managers, behavioral health care managers and social workers. Provide optimized care management delivery for a program governed by a formal Model of Care (MOC). Manager ensures clinically led engagement of the interdisciplinary care team by developing, documenting and communicating member centered care plans. Actively leverages data analytics, formal case audits and one on one coaching to drive performance. Regularly delivers against industry standards, best practices, state/federal regulations, and corporate strategy. Partners with various internal and external stakeholders to drive continuous improvement with an innovative approach to both medical and behavioral health needs. Collaborates with population health on new clinical pathways and engages team to incorporate innovative and focused approach to improved health outcomes.

What you will do:

• Manage case management programs to ensure the delivery of services are aligned with strategic goals. Support integration of behavioral health and medical management.
• Collaborates with internal stakeholders including population health, data analytics, product and member services to drive member focused and compliant delivery supporting improved health outcomes.
• Manages team of care managers, social workers and behavioral health care managers accountable for delivering on model of care commitments.
• Optimize BCBSRI member care management delivery through collaboration with health care partners including, but not limited to accountable care organizations (ACOs), community-based organizations (CBOs), federally qualified health care centers (FQHCs), and community mental health centers (CMHCs).
• Represents BCBSRI with external partners and supports presentation needs both internally and externally.
• Collaborates on the develop of programs, interventions, and effectiveness measurements (evaluations) to support the achievement of departmental objectives and strategic priorities.
• Ensure program compliance with all applicable regulatory guidelines including, but not limited to, NCQA, DOH, CMS, OHIC.
• Monitor department expenses on a regular basis to ensure budget targets are achieved.
• Provide direction and guidance to staff. Set goals, review, and evaluate work, and prepare performance reviews.
• Perform other duties as assigned.
  
  

What you need to succeed:

• Experience in medical and/or behavioral health field.
• Bachelor’s degree in nursing with an Unrestricted RN license, licensed psychologist (doctoral level), licensed independent clinical social worker (LICSW) or licensed mental health counselor (LMHC).
• Minimum of five to seven years’ experience in utilization review, case management, and/or disease management and up to five years clinical practice experience in medical/ behavioral health field or a combination of education and related work experience.
• Minimum of three to five years management experience or experience leading a team.
• Knowledge of managed benefits strategies, utilization review techniques, health care financing and delivery, program development, care management, quality management, and health care administration
• Knowledge of evidence based clinical practice.
• Ability to coach and motivate to maximize performance.
• Ability to effectively communicate goals and business objectives to employees.
• Strong and effective decision-making skills.
• Strong organization and time management skills.
• Proficiency with Microsoft Suite of products (i.e., Word, Excel, PPT, etc.)
• Ability to effectively interact with all levels of the organization.
• Ability to effectively delegate work and manage project tasks.
• Excellent verbal and written communication skills, with ability to convey complex or technical information in an effective manner.
  
  

Extras

• Possession and maintenance of Case Management Certification (CCM) within three (3) years tenure in the position.
• Experience in serving dually eligible populations and or those who experience food and housing insecurity as well as severe and persistent mental illness.
• Proven effectiveness in overseeing and influencing highly efficient and outcome driven teams.
  
  

Location:

BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role:

• In-office: onsite 5 days per week
• Hybrid: onsite 2-4 days per week
• Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia
  
  

At Blue Cross & Blue Shield of Rhode Island (BCBSRI), diversity and inclusion are central to our core values and strengthen our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity, affirmative action employer. We provide equal opportunities without regard to race, color, religion, gender, age, national origin, disability, veteran status, sexual orientation, genetic information and gender identity or expression.

The law requires an employer to post notices describing the Federal laws prohibiting job discrimination based on race, color, sex, national origin, religion, age, equal pay, disability, veteran status, sexual orientation, and genetic information and gender identity or expression. Please visit https://www.eeoc.gov/employers/eeo-law-poster to view the "EEO is the Law" poster.

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