Capital Blue Cross · 10 hours ago
RN Care Manager
United States
Full-time
Remote
Mid Level
$28.25/hr - $53.24/hr
3+ years expCapital Blue Cross is committed to improving the health and well-being of their members and communities. They are seeking an RN Care Manager responsible for coordinating services for members, focusing on education, self-management, and quality care outcomes.
ConsultingHealth CareHealth InsuranceProfessional Services
Responsibilities
The RN Care Manager is responsible for the coordination of services for members who meet established criteria, with an emphasis on education/self-management and promoting quality care and cost-effective outcomes
The Care Manager uses a collaborative process to assess Member needs, review options for services and resources, develop and implement a plan of care, coordinate resources, monitor progress, evaluate Member status, discharge Members, and fully document the individualized member care management process and outcome
The care manager will address, medical, psychosocial, clinical needs, and behavioral health needs including members with mental health and substance use disorder needs
Care Managers provide counseling and referrals to community/local/state programs; collaborate with caregivers, providers, community agencies, behavioral health, and other resources to coordinate care to achieve member’s optimal health status
The Care Manager is responsible for the management and oversight of a caseload of moderate - high risk Members with complex medical/behavioral /psychosocial needs
Uses a collaborative process and serves as a liaison between the participant, family and significant others, behavioral and medical physician(s) and other members of the treatment team
Develops prioritized goals and health actions that assist participants with the implementation of appropriate self-directed care decisions and support improvement in health and self-reliance
Advocates for members and families by helping them to coordinate care and navigate resources to reduce barriers and meet healthcare needs
Analyzes and evaluates referrals for potential enrollment of Members into Care Management Program(s) using established criteria
Conducts assessments to obtain information for a participant-centered plan of care and determination of acuity level, functional status, psychosocial status, and barriers
Obtains consent forms necessary for candidates accepted into the Care Management Program
Applies established criteria for discharge and discharges the Member from the Care Management Program(s) when the criteria are met
Conducts all care management activities, including documentation, in accordance with established departmental policies and procedures
Complies with all Clinical Management and corporate policies and procedures
Builds relationships with members, their families, and implements interventions that move assigned members toward goals of improved knowledge, self-management, and long term care outcomes of stabilization
Identifies and reports quality of care issues in accordance with established departmental policies and procedures
Maintains member confidentiality at all times
Attends company and departmental meetings and training sessions as required
Qualification
Required
Registered Nurse with active licensure in home state; additional state's licensure as needed/required to meet customer needs
Certified Case Management certification within 2 years of employment
At least three (3) years' recent/related experience; care management, home health, medical/surgical behavioral health, and/or critical care preferred
Strong communication skills and the ability to positively interact with customers, peers, leadership, family members, caregivers, visitors, contracted agencies/personnel and the general public
Superior clinical process, critical thinking, and problem-solving skills; and ability to handle critical situations
Excellent written, oral communication, listening, and organizational skills
Ability to use computer system while conversing telephonically
Able to demonstrate strong customer service skills, including tact and diplomacy, both in person and telephonically when communicating with internal and external customers
Ability to appropriately prioritize workload and assignments and perform accurate, detailed and timely completion of assigned duties
Ability to work autonomously and as part of an interdisciplinary team
Demonstrates sound judgment that affirms the rights and responsibilities of Member's, families, health care professionals and health care organizations
Ability to operate a personal computer (PC), including proficiency in Microsoft Office Products
Knowledge of NCQA standards for Population Health Management for health plan accreditation, DMAA standards for disease management and CMSA Standards of Practice for Case Management, Act 68, CMS and ERISA
Maintains knowledge of evidence-based guidelines for chronic conditions/care management
Knowledge of clinical and managed care principles and operations
Knowledge of current and emerging medical treatment modalities and best practice guidelines with the ability to analyze and interpret medical and benefit coverage interrelationships
Knowledge of adult learning principles, motivational interviewing, and intrinsic coaching techniques
Preferred
Health plan experience preferred
Experience in health coaching and motivational interviewing techniques preferred
Compact RN license preferred
Benefits
Medical, Dental & Vision coverage
Retirement Plan
Generous time off including Paid Time Off
Holidays
Volunteer time off
Incentive Plan
Tuition Reimbursement
Company
Capital Blue Cross
At Capital Blue Cross, we promise to go the extra mile for our team and our community.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Todd Shamash
President and CEO
Glenn Heisey
Executive Vice President and Chief Operating Office
Recent News
2025-10-02
2022-10-14
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