Temporary Case Manager

Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, Rhode Island, United States of America Req #1262
Thursday, June 10, 2021

JOB SUMMARY:

  • Assist members in navigating the health care system, ensuring access to evidenced based care. 
  • Educate, empower, and coordinate services for members to improve their health and well being. Facilitate communication between patient, provider, and health plan to ensure members receive the full benefit of integrated care.

 

ESSENTIAL JOB FUNCTIONS:

  • Manage members through the healthcare delivery system; assess needs in order to identify appropriate interventions.  Conduct telephonic health assessments to identify high risk or emerging risk members who would benefit from education and intervention.  Facilitate communication between members, providers, and stakeholders to coordinate and implement action plans aimed at improving the members’ total health.
  • Evaluate action plans by working with members, and collaborating with providers.  Modify action plans as necessary.
  • Monitor and evaluate patient services to ensure appropriate coordination of care.  Collaborate with the Utilization Review process including pre-authorization, concurrent review, screening cases for quality of care issues, and discharge planning. 
  • Promote member and provider satisfaction by demonstrating working knowledge of member benefits, including but not limited to health, disability, Employee Assistance or other plans/benefits available to the member
  • Provide continuity and consistency of care by building positive relationships between the member and family, physicians, provider, care coordinator, and health care plan.
  • Work collaboratively with the team and others necessary to develop and implement solutions. Identify barriers to performing job duties as well as opportunities for improvements. 
  • Exemplifying the corporate values in action through accountability, collaboration, integrity and respect in maintaining a high-performance culture.
  • Perform other duties as assigned.

 

QUALIFICATIONS:

Minimum Education and Experience:

  • A combination of education and applicable experience
  • Unrestricted Rhode Island Nursing License, or unrestricted Registered Dietician License
  • Three to five years experience in a medical/clinical environment or managed health plan


Preferred Education, Additional Qualifications and Experience:

  • Bachelor’s Degree in Nursing
  • Professional nursing certification
  • Experience working in a managed care/health maintenance organization

Required Knowledge, Skills, and/or Abilities:

  • Knowledge of utilization management and/or coordination of care
  • Knowledge of population health and chronic condition management principles
  • Understanding of health care delivery system access points and services
  • Ability to navigate the healthcare delivery system
  • Good business acumen
  • Knowledge of business process improvement techniques and strategies
  • Excellent verbal, written communications and technical skills
  • Decision-making skills
  • Good problem-solving skills
  • Ability to interface with employees at all levels
  • Ability to effectively navigate ambiguous situations with limited direction
  • Excellent organizational skills and ability to successfully prioritize multiple tasks
  • Strong time management skills
At Blue Cross & Blue Shield of Rhode Island (BCBSRI), diversity and inclusion are central to our core values and strengthen our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity, affirmative action employer. We provide equal opportunities without regard to race, color, religion, gender, age, national origin, disability, veteran status, sexual orientation, genetic information and gender identity or expression.
The law requires an employer to post notices describing the Federal laws prohibiting job discrimination based on race, color, sex, national origin, religion, age, equal pay, disability, veteran status, sexual orientation, and genetic information and gender identity or expression. Please visit http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf  to view the "EEO is the Law" poster.

Other details

  • Pay Type Hourly
  • Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, Rhode Island, United States of America