Care Manager - RN (Remote)

PurposeThis RN position supports line of business. Under minimal supervision, the Care Manager researches and analyzes members' medical and behavioral health needs and healthcare cost drivers. The Care Manager works closely with members and the interdisciplinary care team to ensure members have an effective plan of care and a positive member experience that leads to optimal health and cost-effective outcomes. The incumbent will work remotely from within the greater Baltimore metropolitan area and is expected to visit a CareFirst location periodically for meetings, training and other business-related activities.Essential FunctionsIdentifies members with acute/complex medical and/or behavioral health conditions. Engages onsite and/or telephonically with members, family and providers to develop a comprehensive plan of care to address the member's needs at various stages along the care continuum. Identifies relevant CareFirst and community resources and facilitates program, network, and community referrals.Collaborates with member and the interdisciplinary care team to develop a comprehensive plan of care to identify key strategic interventions to address member's medical, behavioral and/or social determinant of health needs. Engages members and providers to review and clarify treatment plans ensuring alignment with medical benefits and policies to facilitate care between settings. Monitors, evaluates, and updates plan of care over time focused on member's stabilization and ability to self-manage. Ensures member data is documented according to CareFirst application protocol and regulatory standards.QualificationsEducation Level: High School Diploma or GED.Licenses/Certifications: RN - Registered Nurse - State Licensure And/or Compact State Licensure RN- Registered Nurse in MD, VA or Washington, DC Upon Hire Required. Must have CCM or other RN Board Certified certification in case management. Incumbents not certified at the time of hire must have two years of case management experience and meet requirements to take CCM exam and successfully achieve the certification within the first year of employment. Upon Hire Preferred.Experience: 5 years clinically related experience working in Care Management, Discharge Coordination, Home Health, Utilization Review, Disease Management or other direct patient care experience.Preferred QualificationsBachelors degree in nursingCCM/ACM or other RN Board Certified certification in case management. Must have CCM/ACM or other RN Board Certified certification in case management. Incumbents not certified at the time of hire must have two years of case management experience and meet requirements to take CCM or ACM exam and successfully achieve the certification within the first year of employment. Upon hire preferred.Knowledge, Skills, and Abilities (KSAs)Knowledge of clinical standards of care and disease processes.Ability to produce accurate and comprehensive work products with minimal direction.Ability to triage immediate member health and safety risks.Basic understanding of the strategic and financial goals of a health care system or payor organization, as well as health plan or health insurance operations (e.g. networks, eligibility, benefits).Excellent verbal and written communication skills, along with the telephonic and keyboarding skills necessary to assess, coordinate and document services for members.Knowledgeable of available community resources and programs.Proficient in the use of web-based technology and Microsoft Office applications such as Word, Excel and PowerPoint.Ability to provide excellent internal and external customer service.Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.Salary Range$72,216 - $143,429Equal Employment OpportunityCareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.Where To ApplyPlease visit our website to apply: in USMust be eligible to work in the U.S. without SponsorshipJ-18808-Ljbffr CareFirst BlueCross BlueShield