QuincyRecruiter Since 2001
the smart solution for Quincy jobs

RN Case Manager l Registered Nurse l Commercial Care

Company: Blue Cross and Blue shield of Massachusetts
Location: Quincy
Posted on: October 11, 2020

Job Description:


The RN Case Manager focuses on arranging and coordinating services that a member needs to get well or stay well. The RN Case Manager also works to remove barriers that prevent the member from engaging in an appropriate plan of care. The RN Case Manager demonstrates strengths working independently as well as collaboratively within a highly matrixed environment.

The RN Case Manager will be working with a team of other dedicated and compassionate nurses and providers to help meet department business objectives and measures. The RN Case Manager will be using a member-centric, collaborative process involving assessment, planning, targeted intervention and advocacy, for our members. The RN Case Manager will work with the member to identify options and services that meet their specific health needs through the health care continuum to promote optimal, cost-effective outcomes.


* Assess and evaluate member or family support needs by using various data tools and resources

* Assist members and their families in the administration of their health plan benefits, promote medication compliance, coordinate care with treatment providers, PCP s and other providers including VNA providers

* Assist the member in shared decision-making and goal setting

* Collaborate within a team of professionals (supervisors, managers, account representatives, member service associates, and physicians) to provide care coordination appropriate for members

* Interpret and apply case management criteria, processes, policies, and applicable regulatory standards

* Interact with treatment providers, PCPs, and physicians as needed to support the plan of care

* Monitor for clinical quality concerns and refers appropriately

* Provides telephone triage and crisis intervention when situation warrants, collaborating with utilization management peers when appropriate

* Will need to understand regulatory requirements for designated programs: Medicare Advantage, Federal Employee Program, Commercial Care and Medex


* Ability to adapt and be flexible to change

* Strong team-work and communication skills as well as ability to be self-directive

* Ability to analyze information to construct effective solutions

* Execution and results (ability to set goals, follow processes, meet deadlines, and deliver expected outcomes with appropriate sense of urgency)

* Cultural competence (demonstration of awareness, attitude, knowledge, and skills to work effectively with a culturally and demographically diverse population)

* Clinical assessment (ability to interpret, evaluate, and clearly document complex medical information using a directive and focused approach in order to identify relevant and actionable conditions, circumstances, and behaviors)

* Care planning (ability to identify and clearly document member-driven, specific, measurable activities that address actionable conditions, circumstances, and behaviors in order to improve health outcomes and cost-effectiveness of services)

* Member collaboration and engagement (ability to secure and maintain the motivation, participation, and collaboration of all relevant parties in a purposeful plan to improve health outcomes and cost-effectiveness of service delivery


* Minimum 3-5 years of direct patient clinical experience, (home care, hospital, or extended care facility)

* Health care professional with active Massachusetts license; Licensure in additional states a plus

* Knowledge of managed care plans and health insurance experience a plus

* Registered Nurse (RN) or other Allied Health professional with active Massachusetts license to practice. Note: any restrictions against a license must be disclosed and reviewed.

* Bachelor s degree preferred in nursing or other allied health field, masters a plus

* Certified Case Manager (CCM) is preferred, required for some roles

* Ability to demonstrate proficiency with multiple Information Technology systems


* Flexibility is required

* Standard working hours are Monday through Friday anywhere from 8am-6pm (Typical shift is 8:30-4:30)

* You may be required to work one evening a week, until 8pm to support our west coast membership

* You may be required to work one Saturday a month to accommodate our member s needs




Full time.

Blue Cross Blue Shield of Massachusetts is an Equal Employment / Affirmative Action Employer. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or expression, or any other characteristics protected by law.

Keywords: Blue Cross and Blue shield of Massachusetts, Quincy , RN Case Manager l Registered Nurse l Commercial Care, Executive , Quincy, Massachusetts

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category

Other Executive Jobs

Commercial Banking Relationship Manager
Description: Commercial Banking Relationship Manager - 2003468 Description Santanders Commercial Banking Division is an active provider of capital, treasury management and risk management solutions to thousands of (more...)
Company: Santander
Location: Boston
Posted on: 10/22/2020

Event/Program Specialist
Description: Adecco is currently assisting a local client in their search to fill an Event/Program Specialist job in Tewksbury, MA. This is a contract opportunity. As an Event/Program Specialist you will be responsible (more...)
Location: Tewksbury
Posted on: 10/22/2020

Time To Re Build with Department Manager at The Paper Store Now Hiring
Description: Department Manager - The Paper StoreThe Paper Store- Department
Company: The Paper Store
Location: Beverly
Posted on: 10/22/2020

Infantryman - Management Training
Description: The Infantry is the backbone of the Army. These Soldiers fill the literal boots on the ground who are responsible for taking or holding ground during any combat operation. You'll attack, repel, and capture (more...)
Company: Army National Guard
Location: Braintree
Posted on: 10/22/2020

Senior Manager, Cell Analytical Development
Description: Key Activities 10 10 Lead the design and execution of development studies that support the development of a cell therapy product. 10 Design and implement novel flow cytometry methods and perform (more...)
Company: Vertex Pharmaceuticals Inc (US)
Location: Boston
Posted on: 10/22/2020

Inside Account Manager
Description: Inside Account Manager, Northeast br br At Sonos we want to create the ultimate listening experience for our customers and know that it starts by listening to each other. As part of the Sonos team, (more...)
Company: Sonos
Location: Boston
Posted on: 10/22/2020

Business Analyst Project Manager - SFIA
Description: Job DescriptionOur client is a Global Human Resource Consulting Firm, redefining the world of work, reshaping retirement and investment outcomes, and unlocking real health and well-being.SummaryThe Business (more...)
Company: M & R Consultants Corporation
Location: Boston
Posted on: 10/22/2020

Quality Investigations Specialist - Pharma Industry
Description: Industry leading global pharmaceutical company is seeking a Quality Investigations Specialist to work in Woburn, MA. br br This a six 6 month temporary contract role, with the
Location: Woburn
Posted on: 10/22/2020

Hourly Restaurant Manager
Description: Job Description: 10 10 Red Robin is taking extra measures to keep our Team Members safe during this time. We have enhanced
Company: Red Robin
Location: Braintree
Posted on: 10/22/2020

ACCS Director
Description: Recognized by the Boston Globe as one of the Top Places To Work, Bay Cove Human Services is a private, not-for-profit corporation that provides a wide variety of services to individuals and their families (more...)
Company: Bay Cove Human Services
Location: Boston
Posted on: 10/22/2020

Log In or Create An Account

Get the latest Massachusetts jobs by following @recnetMA on Twitter!

Quincy RSS job feeds