Clinical Care Navigator for Complex Health Needs

Blue Cross Blue Shield of Massachusetts; Hingham (MA); On-site; USD 56,000 - 68,000; Full time

Benefits offered by this job

paid time off

medical/dental/vision insurance

401(k)

suite of well-being benefits

Job summary

Blue Cross Blue Shield of Massachusetts seeks a Clinical Care Manager to coordinate care for members with complex health needs in a collaborative team. You will assess needs, develop plans, and educate patients while navigating benefits and services.

The role emphasizes strong communication, regulatory knowledge, and commitment to quality care. You will work in a dynamic environment dedicated to improving health outcomes and reducing disparities.

Qualifications

• Active licensure in Massachusetts required for the position.
• 3-5 years in clinical health care settings with case management preferred.
• CCM or related certification is a plus.
• Strong documentation and ability to apply regulatory standards.

Responsibilities

• Assess member and family needs using clinical knowledge and data.
• Promote adherence to treatment plans and shared decision-making.
• Document comprehensive care management plans and criteria.
• Educate members on medications and manage complex pharmacy needs.
• Engage and maintain member participation for seamless care transitions.
• Collaborate with a multidisciplinary team for high-quality care.
• Gather clinical information from providers to support the care plan.
• Monitor quality concerns and escalate appropriately.
• Understand insurance products, benefits, and NCQA requirements.
• Present cases at medical rounds and implement recommendations.
• Foster a diverse and inclusive workplace environment.

Skills

Excellent communication

Critical thinking

Independent work

IT systems proficiency

Goal setting and timelines

Documentation and data interpretation

Education

Active MA licensure (RN/LMHC/LICSW/LCSW)

CCM or similar certification a plus

BSN preferred for RN track

Massachusetts licensure required

Tools

Case management software

Electronic health records

Job description

Blue Cross Blue Shield of Massachusetts seeks a Clinical Care Manager to coordinate care for members with complex health needs in a collaborative team. You will assess needs, develop plans, and educate patients while navigating benefits and services.

The role emphasizes strong communication, regulatory knowledge, and commitment to quality care. You will work in a dynamic environment dedicated to improving health outcomes and reducing disparities.