RN Care Manager

About the role

The Care Manager position at Capital Blue Cross involves coordinating services for members with complex medical, behavioral, and psychosocial needs. Responsibilities include assessing member needs, developing a care plan, coordinating resources, monitoring progress, and documenting the care management process.

Responsibilities

• Serves as a liaison between participants, family members, and healthcare providers.
• Develops and implements a plan of care based on assessments and established criteria.
• Coordinates care and navigates resources to improve health outcomes and reduce barriers.
• Conducts assessments, obtains necessary consent forms, and applies discharge criteria.
• Documents care management activities in accordance with departmental policies and procedures.
• Maintains member confidentiality and reports quality of care issues.
• Attends meetings and training sessions as required.

Qualifications

• At least three (3) years of recent/related experience in care management, home health, medical/surgical behavioral health, or critical care.
• Health plan experience preferred.
• Experience in specialized areas such as oncology, transplant, maternity, or behavioral health.
• Experience in health coaching and motivational interviewing techniques.
• Registered Nurse with active licensure in home state; additional state’s licensure as needed.
• Certified Case Management certification within two years of employment.

Skills

• Strong communication skills and ability to positively interact with various stakeholders.
• Superior clinical process, critical thinking, and problem-solving skills.
• Excellent written, oral communication, listening, and organizational skills.
• Ability to use computer systems, including proficiency in Microsoft Office products.
• Knowledge of NCQA standards, DMAA standards, CMSA Standards of Practice, and evidence-based guidelines for chronic conditions.
• Knowledge of clinical and managed care principles and operations.
• Ability to prioritize workload and assignments accurately and efficiently.
• Ability to work autonomously and as part of an interdisciplinary team.
• Sound judgment that supports the rights and responsibilities of members, families, and healthcare professionals.
• Ability to operate a personal computer and communicate telephonically.

Benefits

Capital Blue Cross offers a comprehensive benefits package including Medical, Dental & Vision coverage, a Retirement Plan, generous time off, an Incentive Plan, Tuition Reimbursement, and more. Employees can volunteer in their community and receive training and continuing education to support professional and personal growth.

Pay

Salary range is influenced by qualifications, experience, and anticipated contributions, with adjustments based on internal pay equity and external market rates. The salary range is not adjusted for geographical location.

Schedule

Flexible schedule to accommodate travel to provider, facility, employer group, and member locations.

Physical Demands

Ability to travel to various locations using own vehicle, if appropriate.