Case Manager Behavioral Health

Blue Cross and Blue Shield of Massachusetts, Inc.; Hingham (MA); Remote; USD 80,000 - 100,000; Full time

Job summary

An innovative healthcare organization is seeking a Clinical Care Manager to enhance member care and support individuals facing health challenges. This role emphasizes independent and collaborative work, focusing on assessing needs and promoting optimal health outcomes. As part of a dedicated team, you'll engage with diverse populations, coordinate care, and navigate complex healthcare systems. Join a forward-thinking company committed to transforming healthcare and fostering a culture of inclusivity and wellness. Your expertise can make a significant impact in the lives of many, making this an exciting opportunity for passionate professionals.

Benefits

Paid Time Off

Medical/Dental/Vision Insurance

401(k) Plan

Well-being Benefits

Qualifications

• Experience in clinical healthcare settings is essential.
• Ability to engage members in care plans and coordinate services.

Responsibilities

• Facilitate care for members with complex healthcare needs.
• Monitor clinical quality concerns and escalate issues as necessary.

Skills

Care Management

Communication Skills

IT Systems Proficiency

Cultural Competence

Education

Active Massachusetts License (LICSW, LMHC, RN)

3-5 years clinical experience

Case Management Certification

Job description

Ready to help us transform healthcare? Bring your true colors to blue.

The Role

The Clinical Care Manager is responsible for facilitating care for members and families of members who may have rising health risks or complex healthcare needs, to promote optimal health. This position is self-directed and works independently and collaboratively to facilitate care based on the principles of care management. Facilitation is focused on assessing needs, identifying healthcare disparities, social determinants of health, and any barriers to care.

This role is eligible for our eWorker, Mobile, and Resident personas. This position can be fully remote, with a 1x/month staff meeting in our Hingham, MA office.

The Team

The Clinical Care Manager is part of a highly dedicated and motivated team of professionals, including medical and behavioral health care managers, dieticians, pharmacists, clinicians, medical directors, and more, who collaborate to facilitate care.

Key Responsibilities:

1. Engage members in appropriate plans of care, coordinate care and services as appropriate, communicate effectively, and provide members with education and resources as needed.

2. Promote member compliance with treatment plans, encourage shared decision-making, and set appropriate goals to promote optimal member outcomes.

3. Interpret and apply case management criteria, processes, policies, and regulatory standards to create, follow, and appropriately document comprehensive care management plans.

4. Review medication lists, educate members with complex pharmacy needs, and counsel on side effects and mitigation strategies for specific treatment protocols.

5. Successfully connect, engage, and maintain member engagement to support seamless care transitions and optimized health outcomes.

6. Interact with treatment providers, PCPs, physicians, therapists, and facilities as needed to gather clinical information to support the plan of care.

7. Monitor clinical quality concerns, make referrals appropriately, and identify and escalate quality of care issues.

8. Understand member insurance products and benefits, as well as regulatory and NCQA requirements.

Key Qualifications:

• Ability to identify and document member-driven, specific, measurable activities that address actionable behaviors and goals.

• Self-directed, independent, adaptive, flexible to change, and able to collaborate as a member of a team.

• Proficient with multiple IT systems.

• Demonstration of awareness, attitude, knowledge, and skills needed to work effectively with a culturally and demographically diverse population.

Education and Experience:

• 3-5 years relevant experience in a variety of appropriate clinical healthcare settings (Inpatient, outpatient, or differing levels of care).

• Case Management experience preferred.

• Substance use care preferred.

• Certifications such as Case Management (CCM), certified diabetic educator, and Wellcoach certification are a plus.

• Active Massachusetts License is required (LICSW, LMHC, and/or RN). Licensure in additional states is a plus. Please note: Any restrictions against a license must be disclosed and reviewed.

#LI-HYBRID

Minimum Education Requirements:

High school degree or equivalent required unless otherwise noted above.

Location

Hingham

Time Type

Full time

Hourly Range: $38.22 - $46.71

The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but not limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer a comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

WHY Blue Cross Blue Shield of MA?

We understand that the confidence gap and imposter syndrome can prevent amazing candidates from applying, so please don't hesitate to apply. We'd love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, your perspectives, and your experiences. It's in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.

As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting our Company Culture page. If this sounds like something you'd like to be a part of, we'd love to hear from you. You can also join our Talent Community to stay "in the know" on all things Blue.

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of employee wellbeing. For more information on how we work and support that work/life balance, visit our "How We Work" Page.