RN Care Manager

🔥 1 minute ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $29 - $54 / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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 who meet established criteria • Educate members and promote self-management, quality care, and cost-effective outcomes • Assess member needs and review service and resource options • Develop and implement individualized plans of care • Coordinate resources and monitor member progress • Evaluate member status and discharge members when criteria are met • Document the individualized member care management process and outcomes • Address medical, psychosocial, clinical, behavioral health, mental health, and substance use disorder needs • Provide counseling and referrals to community, local, and state 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 a liaison among participants, families, physicians, and treatment-team members • Analyze and evaluate referrals for potential program enrollment • Conduct assessments to determine acuity, functional status, psychosocial status, and barriers • Obtain required consent forms • Apply discharge criteria and discharge members from care management programs • Identify and report quality-of-care issues • Maintain member confidentiality • Attend 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 • Knowledge of DMAA standards for disease management • Knowledge of CMSA Standards of Practice for Case Management • Knowledge of 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 clinical process, critical thinking, and problem-solving skills • Ability to work autonomously and as part of an interdisciplinary team • Compact RN license preferred • Care management, home health, medical/surgical behavioral health, and/or critical care experience preferred • Health plan experience preferred • Experience in health coaching and motivational interviewing techniques preferred

🏖️ Benefits

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