Blue Cross Blue Shield of Massachusetts RN Case Manager l Registered Nurse l TrueCare360 in Quincy, Massachusetts
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The telephonic RN Care Manager position is an essential member of the multidisciplinary TrueCare360 program at BCBSMA. This care management position supports a Primary Nurse Model, requires enhanced communication and coaching skills as well as the ability to align with members and their families. This alignment focuses on solving member-centric problems, identifying disparities, addressing barriers to care, and developing patient goals through appropriate targeted interventions. The telephonic RN Care Manager focuses on arranging and/or coordinating services, providing resources, addressing barriers to care, and engagement in appropriate plans of care. These principles and core technology of care management are applied to members across various product lines, benefits, demographics, conditions, and programs to promote optimal health.
Assess and evaluate member needs and benefits by using various data tools and resources
Engage 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 within a team of professionals (supervisors, managers, account representatives, member service associates, 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 and crisis intervention when situation warrants, collaborating with utilization management peers when appropriate
Qualifications and Skills:
Ability to adapt and be flexible to change as priorities within this environment change constantly
Willingness to learn new skills from both a business and clinical perspective
Strong teamwork 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)
Minimum 3-5 years of direct patient care experience: medical-surgical unit, critical care unit, telemetry unit, sub-acute unit, skilled nursing facility, VNA, home care, and/or extended care facilities
Clinical experience in oncology, renal/nephrology and/or pediatrics is desired
Active Massachusetts Registered Nurse (RN) License to practice. Note any restrictions against a license must be disclosed and reviewed. Licensure in additional states a plus
Bachelor’s degree in nursing is preferred; Master's degree is a plus
Certified Case Manager (CCM) is preferred (certification will be required after hire)
Certified Well Coach preferred (certification will be required after hire)
Ability to demonstrate proficiency with Information Technology system
Schedule of Hours:
Flexibility is required
Standard working hours are Monday through Friday anywhere from 8am-6pm (Typical shift is 8:30-4:30)
You may be required to work one evening a week, until 8pm to support our west coast membership
You may be required to work one Saturday a month to accommodate our member’s needs
Remote working ability during Covid pandemic. Post Covid, working from home intermittently may be an option once fully trained (Consideration to work from home intermittently is visited after successful training and the associate has demonstrated that they can work independently, which is typically six plus months after hire)
LocationQuincyTime TypeFull time
Voted as the highest in member satisfaction among Massachusetts commercial health plans by JD Power, Blue Cross Blue Shield of Massachusetts is a community-focused, tax-paying, not-for-profit health plan headquartered in Boston. We have been a market leader for over 75 years, and are consistently ranked among the nation's best health plans. Our daily efforts are dedicated to effectively serving our 2.8 million members, and consistently offering security, stability, and peace of mind to both our members and associates.
Our Commitment to You
We are committed to investing in your development and providing the necessary resources to enable your success. We are dedicated to creating a refreshing and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path. We take pride in our diverse, community-centric, wellness-focused culture and believe every member of our team deserves to enjoy a positive work-life balance.
Blue Cross Blue Shield of Massachusetts is an Equal Employment / Affirmative Action Employer. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or expression, or any other characteristics protected by law.
Blue Cross Blue Shield of Massachusetts will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with Blue Cross Blue Shield of Massachusetts's legal duty to furnish information.