Care Management Program Director

Blue Cross & Blue Shield of Rhode Island; United States; Hybrid; USD 94,000 - 140,000; Full time

Benefits offered by this job

Tuition reimbursement

Student-loan repayment assistance

Health, dental, and vision insurance

Paid time off

Job summary

Blue Cross & Blue Shield of Rhode Island is seeking a leader to manage daily operations of the Case Management department, aligning programs with industry standards and the company’s strategy. This role ensures the delivery of high-quality case management and utilization review services.

Ideal candidates will have a nursing background with an active RN license and 5–7 years in utilization review or case management, plus 3–5 years of managerial experience.

Qualifications

• Bachelor's degree in Nursing or related field with active RN license.
• Five to seven years of experience in utilization review, case management and/or disease management.
• Three to five years of management experience or leading a team.
• Knowledge of managed benefits strategies and health care delivery.
• Strong communication and leadership abilities.

Responsibilities

• Manage daily operations of the department and develop/maintain policies and programs.
• Oversee case management to align with company goals and regulatory standards.
• Evaluate programs for effectiveness and implement improvements.
• Manage department budget and ensure regulatory compliance (NCQA, DOH, CMS, URAC, HIPAA).
• Provide guidance, set goals, and perform staff performance reviews.

Skills

Utilization review

Case management

Disease management

Team leadership

Communication

Microsoft Office

Education

Bachelor's degree in Nursing or related field

Active RN license (NLC)

Job description

Blue Cross & Blue Shield of Rhode Island is seeking a leader to manage daily operations of the Case Management department, aligning programs with industry standards and the company’s strategy. This role ensures the delivery of high-quality case management and utilization review services.

Ideal candidates will have a nursing background with an active RN license and 5–7 years in utilization review or case management, plus 3–5 years of managerial experience.