Case Manager at Blue Cross & Blue Shield of Rhode Island

Pay Range:$73500.00 - $110300.00Please emailif you are a candidate seeking a reasonable accommodation for the application and/or interview process.At BCBSRI our greatest resource is our people.We come from varying backgrounds different cultures and unique experiences. We are hard-working caring and creative individuals who collaborate support one another and grow together. Passion empathy and understanding are at the forefront of everything we donot just for our members but for our employees as well.We recognize that to do your best work you have to be your best self.Its why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health dental and vision insurance as well as programs that support your mental health and well-being. We pay competitively offer bonuses and investment plans and are committed to growing and developing our employees.Our culture is one of belonging.We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where youre at in the organization youre an integral part of our team and your input thoughts and ideas are valued.Join others who value a workplace for all.We appreciate and celebrate everything that makes us unique from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders.Were dedicated to serving Rhode Islanders.Our focus extends beyond providing access to high-quality affordable and equitable care. To further improve the health and well-being of our fellow Rhode Islanders we regularly roll up our sleeves and get to work (literally) in communities all across the statebuilding homes working in food pantries revitalizing community centers and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can our associates receive additional paid time to volunteer.What you will do: Manage membersthrough evidence-based care promote access to healthcare system and assess needs to identify appropriate interventions. Member management includes but is not limited to the conduction of health assessments(telephonic and face-to-face) to identify high-risk or emerging risk members for education and intervention and the evaluation and modification of action plansby working with members and collaborating with providers.Evaluate member services to ensure appropriate levels and coordination of care including pre-authorization concurrent review quality-of-care screening and discharge planning. Ensure member and provider satisfaction by demonstrating knowledge of member plan benefits and community resources.Identify opportunitiesto moderate claims costs for the employer group and individual members. Promote and monitorthe use of wraparound service programs for optimal member experience while managing chronic and acute care needs.Facilitate communicationbetween members providers and stakeholders to coordinate and implement action plans for improving members total health. Provide continuity and consistency of careby building positive relationships between members families providers care coordinators and the health plan.Engage in team operations including supervision team huddles staff meetings case rounds metric management training opportunities department initiatives and projects. Work collaborativelyto develop and implement solutions identify barriers and exemplify corporate values through accountability collaboration integrity and respect.What youll need to succeed: Unrestricted Rhode Island Nursing LicenseUnrestricted Massachusetts Nursing LicenseThree years experience in a medical/clinical environment or managed health planMust obtain Certified Case Manager (CCM) certification within three years of employmentThe extras: Bachelors degree in nursingCertified Case Manager (CCM)Reside in Rhode Island or other Nurse Licensure Compact state (NLC)Bilingual Spanish PortugueseExperience working in a managed care/health maintenance organizationExperience implementing and upholding Quality CMS NCQA requirementsKnowledge of utilization management and/or coordination of careKnowledge of population health and chronic condition management principles aligning with corporate initiatives such as specialty within high-risk maternity and rising risk conditions such as diabetes hypertension COPD etc.Understanding of health care delivery system access points and servicesDemonstration of successful (member) engagement via application of Motivational Interviewing techniques and health coachingAbility to navigate the healthcare delivery systemUnderstanding of evidence-based care programs and approachesStrategic and critical thinking skillsStrong analytical skillsStrong business acumenStrong presentation negotiation problem-solving and decision-making skillsStrong written and verbal communication skillsExperience in health coaching and motivational interview techniquesAbility to work effectively with a wide variety of people in individual and group settingsStrong organizing skills with the ability to prioritize and respond to shifting deadlinesStrong time management skillsLocation: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 weekHybrid: onsite 2-4 days per weekRemote: 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 VirginiaOur culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do and it strengthens our ability to meet the challenges of todays healthcare industry. BCBSRI is an equal opportunity employer.The law requires an employer to post notices describing the Federal laws. Please visit to view the Know Your Rights poster.Required Experience:Manager Key Skills Project Portfolio Management,Motivational Interviewing,HIPAA,Computer Skills,Intake Experience,Lean Six Sigma,Conflict Management,Case Management,Team Management,Program Development,Social Work,Addiction Counseling Employment Type : Full-Time Experience: years Vacancy: 1 Monthly Salary Salary: 73500 - 110300