RN Care Manager

🔥 6 minutes 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: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.Why this score:

• Just posted.
• Jobs at this company usually fill in 21 days.

Apply Now

Find Similar Remote Jobs

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 and promote self-management, quality care, and cost-effective outcomes • Assess member needs, review service and resource options, and develop and implement individualized care plans • Coordinate resources, monitor progress, evaluate member status, and discharge members when criteria are met • 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 team members • Develop prioritized goals and health actions supporting self-directed care and improved health outcomes • Advocate for members and families by coordinating care and navigating resources • Analyze referrals and conduct assessments to determine enrollment, acuity, functional status, psychosocial status, and barriers • Obtain required consent forms • Conduct and document care management activities according to policies and procedures • Build relationships and implement interventions supporting member stabilization, knowledge, self-management, and long-term care outcomes • Identify and report quality-of-care issues • Maintain member confidentiality • Attend required company and departmental meetings and training sessions

🎯 Requirements

• At least three (3) years’ recent/related experience • 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 • 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 • Strong communication, clinical process, critical thinking, and problem-solving skills • Excellent written, oral communication, listening, and organizational skills • Ability to use a computer system while conversing telephonically • Microsoft Office proficiency • Knowledge of NCQA, DMAA, CMSA, Act 68, CMS, and ERISA standards • 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 • Ability to prioritize workload and complete duties accurately and timely • Ability to work autonomously and as part of an interdisciplinary team • Ability to travel to provider, facility, employer group, and/or member locations using own vehicle, if appropriate

🏖️ Benefits

• Medical, Dental & Vision coverage • Retirement Plan • Paid Time Off • Holidays • Volunteer time off • Incentive Plan • Tuition Reimbursement • Flexible work environment • Training and continuing education • Opportunities to volunteer in the community

📊 Check your resume score for this job

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

Upload Resume