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Case Manager

Company Blue Cross Blue Shield of Massachusetts
Location Quincy, MA
Update 6 Day ago
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Care Manager
The Care Manager position is an essential member of the Health and Medical Management program at BCBSMA. This care management position requires enhanced communication as well as the ability to align with members and their families. This alignment focuses on forming member-centric problems and goals, and helping to determine appropriate targeted interventions. The Care Manager also focuses on arranging or coordinating services that the member needs to get well or stay well by removing barriers that prevent the member from engaging in appropriate plans of care. These principles and core technology of case management are applied to members across various product lines, benefits, demographics, conditions, and programs.

Major Responsibilities:
  • Assess and evaluate member needs by using various data tools and resources
  • Assist 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 with supervisors, managers 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, crisis intervention and emergency authorizations as assigned

Qualifications and Skills:

•Ability to adapt and be flexible to change

Strong team-work 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:

3-5 years direct clinical experience

Health care professional with active Massachusetts license; Licensure in additional states a plus

Bachelor’s degree preferred in nursing or other allied health field, masters a plus

Certified Case Manager (CCM) is preferred

Certified Wellness Coaching is preferred

•Ability to demonstrate proficiency with Information Technology systems



Quincy Time Type Full time