Care Manager (Remote)

CareFirst BlueCross BlueShield; Baltimore (MD); Remote; USD 71,000 - 142,000; Full time

Job summary

A leading healthcare organization is seeking a Care Manager to join their team remotely in the Baltimore area. This role involves assessing members' health needs, developing care plans, and collaborating with healthcare teams to ensure optimal outcomes. Candidates must possess an RN license and have at least 5 years of experience in care management or related fields.

Qualifications

• RN license in MD, VA, or DC required.
• CCM certification preferred or must be obtained within the first year.
• Minimum of 5 years in care management or related fields.

Responsibilities

• Identify members with complex medical and behavioral health conditions.
• Develop comprehensive care plans in collaboration with members and providers.
• Monitor member progress towards stabilization and self-management.

Skills

Communication

Documentation

Triage

Understanding of clinical standards

Knowledge of community resources

Proficiency with web-based tools

Proficiency with Microsoft Office

Education

High School Diploma or GED

Job description

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Purpose

Under minimal supervision, the Care Manager researches and analyzes a member's medical and behavioral health needs and healthcare cost drivers. The Care Manager works closely with members and the interdisciplinary care team to ensure members have an effective plan of care and positive member experience that leads to optimal health and cost-effective outcomes. This position supports the Federal Employee Program line of business and requires working remotely within the greater Baltimore metropolitan area, with periodic visits to a CareFirst location for meetings, training, or other activities.

Responsibilities & Qualifications

• Identify members with complex medical and behavioral health conditions; develop comprehensive care plans in collaboration with members, families, and providers; facilitate referrals to CareFirst and community resources.
• Collaborate with the care team to develop and update care plans, ensuring alignment with benefits and policies, and monitor member progress towards stabilization and self-management.

Qualifications

• Education: High School Diploma or GED required.
• Licenses: RN license in MD, VA, or DC; CCM certification preferred or must be obtained within the first year if not already certified.
• Experience: Minimum of 5 years in care management, discharge coordination, home health, utilization review, or related fields.

Knowledge, Skills & Abilities

• Understanding of clinical standards and disease processes.
• Strong communication, documentation, and triage skills.
• Knowledge of community resources and proficiency with web-based tools and Microsoft Office.

Additional Details

• Salary Range: $71,496 - $141,999
• Travel: Occasionally required
• Department: PPO Care Management

For application details, visit: carefirst.com/careers

CareFirst is an Equal Opportunity Employer. Must be eligible to work in the U.S. without sponsorship.