Direct Clinical Care Manager (NP)

Blue Cross Blue Shield of Massachusetts; Hingham (MA); On-site; USD 115,000 - 141,000; Full time

Benefits offered by this job

Medical/dental/vision insurance

401(k)

Paid time off

Well-being benefits

Variable pay eligibility

Job summary

Blue Cross Blue Shield of Massachusetts is seeking a Direct Care Clinical Care Manager (Nurse Practitioner) to facilitate and deliver care to members, improving access and outcomes through preventive screenings and chronic disease management.

The role is based in Massachusetts, requires an NP license, and involves telehealth visits, care coordination, and collaboration with physicians, care managers, and other professionals to design innovative virtual care and ensure seamless transitions for

Qualifications

• Licensed NP in Massachusetts with 3-5 years care delivery experience.
• Ideally 10+ years in ambulatory care, preferably as primary care provider.
• Demonstrated patient engagement and relationship management.

Responsibilities

• Conduct telehealth visits by video and phone with BCBSMA members.
• Manage chronic diseases for Medicare-age members (hypertension, diabetes).
• Co-design an innovative virtual care program with Medical Director support.
• Use EMR workflows and documentation effectively.
• Engage members in plans of care and coordinate services as needed.
• Promote adherence to treatment plans and shared decision-making.

Skills

Telehealth visits

Chronic disease management

Patient engagement

Care coordination

EMR workflows

Education

Nurse Practitioner license (MA)

3-5 years care delivery experience

10+ years ambulatory care experience

Tools

EMR systems

Multiple IT systems

Job description

The Role

The Direct Care Clinical Care Manager is 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 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 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.
• Understand BCBSMA 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

• 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' experience in ambulatory care, preferably as primary care provider for a population of patients.
• Proven abilities in 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.

For more information on how we work and support that work/life balance visit our "How We Work" Page.