Direct Clinical Care Manager

Blue Cross Blue Shield of Massachusetts; United States; Remote; USD 115,000 - 141,000; Full time

Job summary

Blue Cross Blue Shield of Massachusetts is seeking an NP Direct Care Clinical Care Manager to lead telehealth care and coordinate services for Medicare-age members. The role focuses on hypertension and diabetes management, workflow design, and collaboration with medical leadership to expand clinical scope.

You will use EMR systems, engage members in care plans, and work with PCPs and other providers to ensure timely follow-up and education.

Qualifications

• Must be licensed as an NP in Massachusetts with 3–5 years of care delivery experience.
• Ideally 10+ years of ambulatory care experience.
• Proven abilities in patient engagement and relationship management.
• Proficient with multiple IT systems used in care delivery.

Responsibilities

• Conduct telehealth visits by video and phone with BCBSMA members, with varying volume each week and likely daily visits.
• Manage chronic diseases for Medicare-age members, focusing on hypertension and diabetes via remote workflows.
• Co-design an innovative virtual care program with workflows and clinical protocols with Medical Director support.
• Use electronic medical record workflows and documentation effectively.
• Engage members in plans of care, coordinate services, and provide education and resources.
• Promote adherence to treatment plans and shared decision-making to improve outcomes.
• Interpret and document case management criteria, processes, and regulatory standards.
• Review medication lists and counsel on side effects for complex therapies.
• Connect and maintain member engagement to support seamless care transitions.
• Collaborate with PCPs, physicians, therapists, and facilities to gather clinical information.
• Monitor quality concerns, make referrals, and escalate issues as needed.
• Understand BCBSMA products, benefits, and regulatory/NCQA requirements.

Skills

Telehealth delivery

Care coordination

Chronic disease management

Patient education

Team collaboration

IT systems proficiency

Education

Nurse Practitioner license (MA)

Ambulatory care experience

Tools

EMR systems

Job description

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

The Role
The Direct Care Clinical Care Manageris responsible for facilitating and delivering care to members to increase access to care and improve clinical outcomes. This position is self-directed and works collaboratively to close identified gaps in care, focusing on preventive screenings, management of chronic disease, and facilitating necessary follow-up care.

The Team

The Direct Care Clinical Care Manager is part of a dedicated team of professionals, including medical and behavioral health care managers, dieticians, pharmacists, clinicians, and medical directors, all collaborating to facilitate clinically appropriate quality care.

KeyResponsibilities

• Conduct telehealth visits by video and phone with BCBSMA members, with varyingvolumeeach weekand likely daily visits.
• Chronic disease management for Medicare-age members, specifically hypertension and diabetes via remote workflows.
• Creatively co-design an innovative virtual care program, including workflows and clinical protocols with Medical Director support for expanding clinical scope.
• Effective use of electronic medical record workflows and documentation.
• Engage members in appropriate plans of care, coordinate care and services as appropriate, communicate effectively,and provide members with education and resources as needed.
• Promote member compliance with treatment plan, encourage shared decision-making, and set appropriate goals to promote optimal member outcomes.
• Interpret and apply case management criteria, processes, policies, and regulatory standards to create, follow and appropriately document comprehensive care management plans.
• Review medication list and educate members with complex pharmacy needs, and counsel on side effects and mitigation strategies for specific treatment protocols.
• Successfully connect, engage, and maintain member engagement to support seamless care transitions and optimized health outcomes.
• Collaborate with treatment providers, PCPs, physicians, therapists, and facilities as needed to gather clinical information to support the plan of care.
• Monitor clinical quality concerns, make referrals appropriately, identify and escalation quality of care issues.
• UnderstandBCBSMAproducts 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

• Currently licensed as an NP in Massachusetts with 3-5 years recent experience in care delivery and willing to continue clinical practice.
• Ideally 10+years’ experiencein ambulatory care, preferably as primary care provider for a population of patients.
• Proven abilitiesin patient engagement and relationship management.

Minimum Education Requirements:

High school degree or equivalent required unless otherwise noted above

Location

Boston, Hingham

Time Type

Full time

Salary Range: $115,200.00 - $140,800.00

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 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 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 coming our way. 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’ll 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 associate wellbeing. For more information on how we work and support that work/life balance visit our \"How We Work\" Page.