[Hiring] Case Manager, RN @Excellus BCBS

Role Description

Conducts case management program activities in accordance with departmental, corporate, NYS Department of Health (DOH), Centers for Medicaid & Medicare Services (CMS), Federal Employee Program (FEP) and National Committee for Quality Assurance (NCQA) accreditation standards, as appropriate to the member’s case assignment. Uses a systematic approach to identify members meeting program criteria; assessing for opportunities to educate, support, coach, coordinate care and review treatment options, through collaboration with providers and community-based resources.

Participates in a cross functional, multi-disciplinary team to identify and implement member-centric interventions to ensure optimal and cost-effective health outcomes. Collaborates with interdisciplinary care team to develop a comprehensive care plan to identify key strategic interventions to address member’s needs, health goals and mitigate health care cost drivers.

Qualifications

• Associates degree required. Bachelor’s degree preferred.
• Active NYS RN or Registered Dietician or Physical Therapist licensure required.
• Minimum of three years of clinical experience required. Case Management experience preferred.
• Must demonstrate proficiency with the Microsoft Office Suite.
• Experience in interpreting managed care benefit plans and strong knowledge of government program contracts (Medicare and Medicaid) preferred.
• Strong written and verbal communication skills.
• Ability to multitask and balance priorities.
• Must demonstrate ability to work independently on a daily basis.
• Deliver efficient, effective, and seamless care to members.
• For incumbents aligned to the Federal Employee Program (FEP) line of business, Case Management Certification required within two (2) years of either hire and/or moving into this role supporting the FEP LOB.
• For incumbents aligned to Hospital to Home program only, active NYS RN license required with three years’ behavioral health experience; or LMSW; or LCSW; or LMHC required.

Requirements

• Handles physical health member clinical management programs.
• Maintains knowledge of current Case Management Society of America (CMSA) Standards, NCQA Standards, Case Management Program activities.
• Carries out job responsibilities in accordance with departmental, corporate, state, federal and accreditation standards.
• Maintains confidentiality and conducts information management procedures per corporate and departmental policy.
• Implements the Case Management Process per department policies, procedures and guidelines.
• Screens members that fall within the defined populations served.
• Initiates case management, as outlined in the Case Management Program Description.
• Works in collaboration with members’ physicians and other health care providers.
• Assesses member/caregiver knowledge of his/her illness and initiates appropriate education interventions.
• Collaborates with member/caregiver to determine specific objectives, goals and actions.
• Provides appropriate resources and assistance to members.
• Participates in inter-disciplinary coordination and collaboration.
• Accepts responsibility for continuing education relative to professional growth.
• Participates in and promotes other health plan programs.
• Works collaboratively with all Case Managers.
• May work with internal and external stakeholders for value-based payment programs.
• Consistently demonstrates high standards of integrity.
• Maintains high regard for member privacy.
• May participate in the orientation of new staff.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

Benefits

• Compensation Range(s):
• Level I: Grade E2: Minimum: $62,400 - Maximum: $96,081
• Level II: Grade E3: Minimum: $62,400 - Maximum: $106,929
• Level III: Grade E4: Minimum: $65,346 - Maximum: $117,622
• Participation in group health and/or dental insurance.
• Retirement plan.
• Wellness program.
• Paid time away from work.
• Paid holidays.

Company Description

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.