[Hiring] RN Care Manager @Capital Blue Cross

Role Description

The Care Manager is responsible for the coordination of services for members who meet established criteria, with an emphasis on education/self-management and promoting quality care and cost-effective outcomes. The Care Manager uses a collaborative process to:

• Assess Member needs
• Review options for services and resources
• Develop and implement a plan of care
• Coordinate resources
• Monitor progress
• Evaluate Member status
• Discharge Members
• Fully document the individualized member care management process and outcome

The Care Manager will address:

• Medical needs
• Psychosocial needs
• Clinical needs
• Behavioral health needs, including mental health and substance use disorder needs

Care Managers provide counseling and referrals to community/local/state programs, collaborate with caregivers, providers, community agencies, behavioral health, and other resources to coordinate care to achieve member’s optimal health status. The Care Manager is responsible for the management and oversight of a caseload of moderate - high risk Members with complex medical/behavioral/psychosocial needs.

Qualifications

• Strong communication skills and the ability to positively interact with customers, peers, leadership, family members, caregivers, visitors, contracted agencies/personnel, and the general public.
• Superior clinical process, critical thinking, and problem-solving skills; ability to handle critical situations.
• Excellent written, oral communication, listening, and organizational skills.
• Ability to use computer systems while conversing telephonically.
• Able to demonstrate strong customer service skills, including tact and diplomacy, both in person and telephonically.
• Ability to appropriately prioritize workload and assignments and perform accurate, detailed, and timely completion of assigned duties.
• Ability to work autonomously and as part of an interdisciplinary team.
• Demonstrates sound judgment that affirms the rights and responsibilities of Members, families, health care professionals, and health care organizations.
• Ability to operate a personal computer (PC), including proficiency in Microsoft Office Products.

Requirements

• At least three (3) years’ recent/related experience; care management, home health, medical/surgical behavioral health, and/or critical care preferred. Health plan experience preferred.
• Additional experience related to specialized positions (Oncology, Transplant, Maternity, Behavioral Health) will also be considered.
• Experience in health coaching and motivational interviewing techniques preferred.

Education and Certifications

• Registered Nurse with active licensure in home state; additional state’s licensure as needed/required to meet customer needs.
• Certified Case Management certification within 2 years of employment.
• Compact RN license preferred.

Physical Demands

• Ability to travel to provider, facility, employer group, and/or member locations using own vehicle, if appropriate.

Benefits

• Comprehensive benefits package including Medical, Dental & Vision coverage
• Retirement Plan
• Generous time off including Paid Time Off, Holidays, and Volunteer time off
• Incentive Plan
• Tuition Reimbursement
• And more