RN Case Manager - Behavioral Health

• →Continually assess and evaluate member and family needs utilizing strong communication skills, critical thinking, clinical knowledge, data, and tools.
• →Promote member compliance with treatment plan, encourage shared decision-making, and set appropriate goals to promote optimal member outcomes.
• →Interpret and apply case management criteria, processes, policies, and regulatory standards to create, follow and appropriately document comprehensive care management plans.
• →Review medication list and educate members with complex pharmacy needs, and counsel on side effects and mitigation strategies for specific treatment protocols.
• →Successfully connect, engage, and maintain member engagement to support seamless care transitions and optimized health outcomes.
• →Collaborate within a team of professionals, including clinical utilization managers, account representatives, member service associates, dietitians, and physicians, to provide members with a high level of care coordination.
• →Interact with treatment providers, PCPs, physicians, therapists, and facilities as needed to gather clinical information to support the plan of care.
• →Monitor clinical quality concerns, make referrals appropriately, identify and escalate quality of care issues.
• →Understand member insurance products and benefits, as well as regulatory and NCQA requirements.
• →Identify cases to be presented at medical rounds and follow up with providers on recommendations to achieve optimal outcomes for members.
• →Support a positive workplace environment, collaborate, and share clinical knowledge and skills to support our culturally and demographically diverse member population.
• →Other clinical duties as assigned.

• Ability to identify and document member-driven, specific, measurable activities that address actionable behaviors and goals

• Self-directed, independent, adaptive, flexible to change, and able to collaborate as a member of a team.
• Ability to assess, analyze, draw conclusions, and construct effective solutions.
• Excellent written and verbal communication skills.
• Proficient with multiple IT systems.
• Able to identify and set goals, follow processes, meet deadlines, and deliver expected outcomes with the appropriate sense of urgency.
• Ability to interpret, evaluate, and document complex medical information to identify relevant and actionable conditions, circumstances, and behaviors.
• Demonstration of awareness, attitude, knowledge, and skills needed to work effectively with a culturally and demographically diverse population.
• Willingness to learn new business and clinical skills

We understand that the confidence gap and imposter syndrome can  prevent  amazing candidates coming our way, so please don’t hesitate to apply. We’d love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It’s in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.

As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting our Company Culture page. If this sounds like something you’d like to be a part of, we’d love to hear from you. You can also join our Talent Community to stay “in the know” on all things Blue.

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work" Page.