Direct Clinical Care Manager (NP)

Blue Cross and Blue Shield of Massachusetts, Inc.; Boston (MA); On-site; USD 115,000 - 141,000; Full time

Benefits offered by this job

Variable pay eligibility

Benefits package (health/dental/vision

Job summary

Blue Cross Blue Shield of Massachusetts, Inc. is seeking a Direct Care Clinical Care Manager (NP) in Boston to facilitate and deliver care, close gaps, and focus on preventive screenings and chronic disease management.

The role requires MA licensure and 3–5 years of care delivery experience, with a preference for ambulatory care background. The position involves telehealth visits, EMR workflows, and collaboration with a multidisciplinary team to improve patient outcomes and ensure regulatory

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.

Responsibilities

• Conduct telehealth visits by video and phone with BCBSMA members, with varying volume each week and 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 education and resources.
• Promote member compliance with treatment plan, encourage shared decision-making, and set appropriate goals to promote optimal outcomes.
• Interpret and apply case management criteria, processes, policies, and regulatory standards to create and document care plans.
• Review medication lists and educate members with complex pharmacy needs.
• Connect, engage, and maintain member engagement to support seamless care transitions.
• Collaborate with treatment providers, PCPs, physicians, therapists, and facilities to gather clinical information.

Skills

Self-directed

IT systems

Cultural competence

Patient engagement

Education

Nurse Practitioner license (MA)

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.

Must be a licensed Nurse Practitioner in the state of MA.

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.

Key Responsibilities

• 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.
• Collaboratewith 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 escalatquality 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 andrelationship management.

Minimum Education Requirements: High school degree or equivalent required unless otherwise noted above

Location

Location: Boston, Hingham

Time Type

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. 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.

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.