The Care Manager RN leads the coordination of a multidisciplinary team to deliver a holistic, person centric care management program to a diverse health plan population with a variety of health and social needs. They serve as the single point of contact for members, caregivers, and providers using a variety of communication channels including phone calls, emails, text messages and the BCBSM online messaging platform. The Care Manager RN uses the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the member's health across the care continuum. They work in partnership with the member, providers of care and community resources to develop and implement the plan of care and achieve stated goals.
Fully remote telephonic position. This position requires outbound calls to members to engage them into the program with continuous telephonic outbound calls for ongoing care plan goals. Members may also request to interact via our digital app, instead of telephonically.
As a care manager you will need to use motivational interviewing skills to engage members into the free program. Currently Care Managers are calling members that do not know they have been identified for the program and we are looking at opportunities for other team members to make these outreaches in the future.
Note: All specialties are needed including Pediatrics, also working hours up to 8pm EST may be expected. This position is fully remote. To work remote your internet speed must be 25mbps or higher, please check with your Internet provider to confirm that you have enough speed.
Lead the coordination of a regionally aligned, multidisciplinary team to provide holistic care to meet member needs telephonic and/or digitally. The multidisciplinary team is inclusive of Medical and Behavioral Health Social Workers, Registered Dietitians, Pharmacists, Clinical Support Staff and Medical Directors.
Monitor and evaluate effectiveness of the care management plan, assess adherence to care plan to ensure progress to goals and adjust and reevaluate as necessary.
Accurately document interactions that support management of the member.
Prepare the member and/or caregiver for discharge from a facility to home or for transfer to another healthcare facility to support continuity of care.
Educate the member and/or caregiver about post-transition care and needed follow-up, summarizing what happened during an episode of care.
Secure durable medical equipment and transportation services and communicate this to the member and/or caregiver and to key individuals at the receiving facility or home care agency.
Adhere to professional standards as outlined by protocols, rules and guidelines meeting quality and production goals
Continue professional development by completing relevant continuing education and maintaining Certified Case Manager (CCM).
Licenses and Certifications • RN - Registered Nurse - Multi-State-Licensure, RN - Must reside and be licensed in the same state that is part of the Nurse Compact
Department Preference
Must have exemplary computer skills and be able to utilize multiple systems when interacting with members/providers - Strongly Preferred
QUALIFICATIONS
Nursing Diploma or associate degree in nursing required.
Bachelor's degree in nursing strongly preferred.
3 years of clinical nursing experience in a clinical, acute/post-acute care, and community setting required.
1 year of case management experience in a managed care setting strongly preferred.
Experience managing patients telephonically and via digital channels (mobile applications and messaging) preferred.
Certification in Case Management (CCM) required or to be obtained within 18 months of hire
Certification in Chronic Care Professional (CCP) preferred
Ability to think critically, be decisive, and problem solve a variety of topics that can impact a member's outcomes.
Must have intermediate computer knowledge, typing capability and proficiency in Microsoft programs (Excel, OneNote, Outlook, Teams, Word, etc.).
