Case Manager, RN

Premera Blue Cross; Washington; Remote; USD 85,000 - 110,000; Full time

Job summary

Premera Blue Cross is seeking Case Managers to support members through a whole-person care model. You will assess health needs, identify barriers, and empower meaningful progress toward better daily living.

This telecommuter role offers collaboration with clinicians, care teams, and providers, with a focus on documentation, coordination, and culturally informed care. You will maintain licensure and pursue certifications as needed.

Qualifications

• Active WA State or Compact RN/ARNP license allowing independent assessment.
• 3 years' post-licensure direct care experience.
• 1 year post-licensure case management experience (care coordination/ discharge planning).
• CCM certification preferred; must obtain within 24 months if not at hire.
• Bachelor's or Master's degree preferred.
• 4+ years direct care across multiple populations/settings recommended.
• Motivational interviewing experience.
• Chronic Condition Certifications (Asthma, Cardiology, Diabetes, etc.).
• Integrated Case Management certificate (ICM).
• CDP certification and LEAN training a plus.

Responsibilities

• Engage members facing medical utilization disorders and build rapport for open dialogue.
• Conduct holistic health assessments and identify social determinants of health.
• Develop member-centric care plans with caregivers and providers.
• Monitor and update the plan to ensure progress toward goals.
• Facilitate communication and coordination among the health care team.
• Provide interventions to remove barriers and support behavior change.
• Maintain accurate documentation meeting accreditation and legal requirements.

Skills

Active WA State or Compact RN/ARNP lic

3 years post-licensure direct care exp

1 year post-licensure case management

Motivational interviewing experience

LEAN training

Education

Bachelor's or Master's degree

Job description

Workforce Classification:

Telecommuter

Join Our Team: Do Meaningful Work and Improve People's Lives

Our purpose, to improve customers' lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

Premera is committed to being a workplace where people feel empowered to grow, innovate, and lead with purpose. By investing in our employees and fostering a culture of collaboration and continuous development, we're able to better serve our customers. It's this commitment that has earned us recognition as one of the best companies to work for. Learn more about our recent awards and recognitions as a greatest workplace. (https://www.premera.com/visitor/careers#awards)

Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.premera.com/ .

Our Case Managers are a compassionate team of clinicians who support members through a whole‑person care model. We partner with individuals to understand their unique medical health needs, remove barriers, and empower meaningful progress toward emotional well‑being and healthier daily living.

Who we serve:

Premera Blue Cross, a nationally recognized leader in the practice of integrated case management, is looking to expand our growing team of Case Managers. Our comprehensive, whole-person health assessment helps to identify member actionable barriers and develop obtainable goals that will eventually lead to self-care. In the interim, case managers employ an integrated case management approach that recognizes making lifestyle changes is not simple and meets members where they are. We also monitor progress toward goals and facilitate the coordination of providers as needed. Our market-differentiated approach has helped thousands of members make meaningful improvements to their daily habits, health, and overall well-being.

What you will get in this role:

• The opportunity to help members in a meaningful and impactful way. We know that helping people is important to you.
• The opportunity to learn and grow. You will be working with folks who literally wrote the book on integrated case management.
• The opportunity to have an impact. Your work improves the lives of our members and enables us to operate more impactfully.
• The opportunity to thrive in a career. We offer a supportive and safe environment where clinicians can work to the top of their licensure.
• The opportunity to take pride. We know your work is important just as you do.

What you will do:

• Engage members who are facing medical utilization disorders and build a relationship that will support open and constructive dialog on sensitive topics.
• Conduct initial holistic health assessments that help build an understanding of a member's specific situation and needs and identify any social determinants of health (SDOH) and cultural influences that may impact potential lifestyle changes.
• Create a space where a case manager and member can collaborate, along with relevant caregivers and providers, to develop a member-centric case management plan that sets goals, addresses potential barriers, and leads to improved health outcomes.
• Monitor, evaluate, and update the effectiveness of the member's case management plan to ensure progress toward goals is being made and that current goals remain pertinent.
• Facilitate communication and coordination among the health care team to maximize delivery of appropriate care.
• Provide interventions focused on removing barriers, promoting positive behavior change using motivational interviewing techniques, and stabilizing the members' natural support systems by ensuring that caregiver needs are identified and being met.
• Maintain concise, accurate, and timely documentation that meets accreditation, contractual, and legal requirements.

What you will bring:

Required:

• Active WA State or Compact RN or ARNP license that allows you to conduct an assessment independently.
• 3 years' post licensure direct care experience.
• 1 year of post-licensure case management experience involving care coordination, care planning, discharge planning, or management of patient care over time

Preferred:

• Certified Case Manager (CCM) certification. If applicants do not have their CCM certification at hire, then they are required to obtain within 24 months of hire.
• Bachelor's or Master's degree
• 4 or more years direct care experience across multiple patient populations, conditions, or care settings
• Motivational interviewing experience
• Chronic Condition Certifications (Asthma, Cardiology, Diabetes, High Risk Maternity, Oncology, Pediatrics)
• Integrated Case Management certificate (ICM)
• Chemical Dependency Professional (CDP) certification
• LEAN training

Conditional Requirements:

• Individuals residing outs