RN Care Manager

🔥 0 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $28 - $53 / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Capital Blue Cross

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1938

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

Capital Blue Cross is a health insurance company that offers a range of health plans for individuals, families, and employers. They serve customers in Central Pennsylvania and the Lehigh Valley, focusing on providing health coverage services such as Medicare plans, student health plans, and resources for managing medical care. Capital Blue Cross positions itself as a partner in health, emphasizing support for members' overall wellness and preventive health measures.

📋 Description

• Coordinate services for members meeting established criteria • Educate members, promote self-management, quality care, and cost-effective outcomes • Assess member needs, review service and resource options, develop and implement plans of care • Coordinate resources, monitor progress, evaluate member status, discharge members, and document care management processes and outcomes • Address medical, psychosocial, clinical, behavioral health, mental health, and substance use disorder needs • Provide counseling and referrals to community, local, state, and other programs • Collaborate with caregivers, providers, community agencies, behavioral health teams, and other resources • Manage and oversee a caseload of moderate- to high-risk members with complex needs • Serve as liaison among participants, families, physicians, and treatment teams • Develop prioritized goals and health actions supporting self-directed care and improved health • Advocate for members and families, helping coordinate care and navigate resources • Analyze referrals and assess candidates for enrollment using established criteria • Obtain required consent forms • Apply discharge criteria and discharge members from care management programs • Conduct activities according to departmental and corporate policies and procedures • Build member and family relationships and implement interventions toward improved knowledge, self-management, and long-term outcomes • Identify and report quality-of-care issues • Maintain member confidentiality • Attend required company and departmental meetings and training sessions

🎯 Requirements

• Registered Nurse with active licensure in home state • Additional state 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 • Knowledge of NCQA standards for Population Health Management, DMAA standards, CMSA Standards of Practice, Act 68, CMS and ERISA • 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 • Knowledge of adult learning principles, motivational interviewing, and intrinsic coaching techniques • Proficiency in Microsoft Office Products • Strong communication, clinical process, critical thinking, problem-solving, written, oral, listening, organizational, and customer service skills • Ability to prioritize workload, complete duties accurately and timely, work autonomously and in an interdisciplinary team • Ability to use a computer system while conversing telephonically • Ability to travel using own vehicle to provider, facility, employer group and/or member locations, if appropriate

🏖️ Benefits

• Medical, Dental & Vision coverage • Retirement Plan • Paid Time Off • Holidays • Volunteer time off • Incentive Plan • Tuition Reimbursement • Training and continuing education • Flexible work environment • Community volunteering opportunities