Blue Cross & Blue Shield of Rhode Island · 1 day ago
DSNP RN Care Manager
United States
Full-time
Remote
Mid Level
$74K/yr - $110K/yr
3+ years expBlue Cross & Blue Shield of Rhode Island is dedicated to improving the health and well-being of Rhode Islanders. The DSNP RN Care Manager role involves managing members through the healthcare delivery system, conducting health assessments, and facilitating communication among members, providers, and stakeholders to improve overall health outcomes.
Insurance
Responsibilities
Manage members through the healthcare delivery system; assess needs in order to identify appropriate interventions
Conduct telephonic or face to face 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
Identify opportunities to impact claims expense trends for the all lines of business/or at the individual member level
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
Participate in department initiatives and projects. Perform other duties as assigned
Qualification
Required
A combination of education and related work experience
Active and unrestricted RN license issued by a state participating in the Nurse Licensure Compact (NLC)
Three to five years' experience in a medical/clinical environment or managed health plan
Expertise working with D-SNP beneficiaries
Must obtain Certified Case Manager (CCM) certification within three years of employment
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
Negotiation skills
Presentation 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
Ability to handle multiple priorities/projects
Strong time management skills
Preferred
Professional nursing certification
Experience working in a managed care/health maintenance organization
Bilingual preferred
Benefits
Flexible work arrangements that include remote and hybrid opportunities
Paid time off
Tuition reimbursement
Assist with student-loan repayment
Health, dental, and vision insurance
Programs that support your mental health and well-being
Bonuses and investment plans
Additional paid time to volunteer
Company
Blue Cross & Blue Shield of Rhode Island
At Blue Cross & Blue Shield of Rhode Island (BCBSRI), we know that health is more than what happens at the doctor’s office.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Martha Wofford
President and CEO
James Joy
Chief Financial Officer - Retired
Company data provided by crunchbase