RN Clinical Care Manager: Complex Health Navigator

bcbsma; Hingham; On-site; GBP 68,000 - 83,000; Full time

Benefits offered by this job

Paid time off

Medical/dental/vision insurance

401(k) retirement plan

Well-being benefits

Job summary

Blue Cross Blue Shield of Massachusetts in Hingham, MA is seeking a Clinical Care Manager to facilitate care for members with rising health risks or complex needs. This self-directed role works with an interprofessional team to assess needs, coordinate services, and promote optimal health outcomes.

Key duties include engaging members in care plans, reviewing medications with complex needs, and collaborating with PCPs and providers.

Qualifications

• 3-5 years in clinical health care settings.
• Utilization Management experience preferred.
• Active licensure in Massachusetts required (RN/PT).
• Licensure in additional states a plus.
• Note: Any restrictions against a license must be disclosed and reviewed.

Responsibilities

• Engage members in appropriate plans of care and coordinate services.
• Interpret and apply case management criteria and document care plans.
• Review medication lists and educate on side effects for complex needs.
• Maintain member engagement for seamless care transitions and outcomes.
• Collaborate with providers to gather clinical information for the plan of care.
• Monitor quality concerns and make referrals as needed.

Skills

Self-directed

Independent

Cultural competence

IT systems

Team collaboration

Education

RN/PT licensure

Massachusetts licensure

High school degree

Job description

Blue Cross Blue Shield of Massachusetts in Hingham, MA is seeking a Clinical Care Manager to facilitate care for members with rising health risks or complex needs. This self-directed role works with an interprofessional team to assess needs, coordinate services, and promote optimal health outcomes.

Key duties include engaging members in care plans, reviewing medications with complex needs, and collaborating with PCPs and providers.