Manager, Case Management

Premera Blue Cross; United States; Hybrid; USD 89,000 - 152,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

401(k) + pension plan

Tuition assistance

Job summary

Premera Blue Cross is hiring a Manager, Case Management to lead and develop the Clinical Programs team. This role ensures strategic execution, oversees operations, and drives improvement initiatives across case management processes.

Ideal candidates have RN licensure, CCM certification or plan to obtain within 24 months, and at least five years in case management plus three years in management. Strong Lean/quality improvement experience is a plus.

Qualifications

• RN license preferred
• Current licensure allowing independent assessments within scope of practice
• CCM certification required or to be obtained within 24 months
• Five years of case management or health care experience
• Three years of management experience
• Advanced degree preferred (e.g., MS/MPH)
• Experience with NCQA/URAC/accreditation processes
• Experience with continuous process improvement (LEAN)
• Advanced training in Motivational Interviewing
• Experience training clinical and non-clinical staff
• Experience managing case management teams and integrated models

Responsibilities

• Participate in development of Clinical Programs’ strategy and planning aligned with mission and regulatory standards
• Lead Care Management teams and oversee case management activities
• Develop and monitor department budgets
• Establish and monitor performance standards using quality improvement methods
• Foster a collaborative, inclusive team environment and cross-functional relationships
• Ensure regulatory compliance (NCQA, URAC, etc.)
• Provide oversight and development for staff to achieve productivity
• Use data to monitor performance and address opportunities timely
• Cultivate partnerships with internal and external stakeholders

Skills

Team leadership

Case management

Quality improvement

LEAN

Motivational Interviewing

Staff training

Process optimization

Data-driven decisions

Education

Master’s degree in health field

CCM certification

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 beinga 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’sthis commitment that has earned us recognition as one of the best companies to work for.

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

Please note this position aligns to PST business hours.

The Manager, Case Management Team is a Supervisor for Case Managers. This position is responsible for the execution and implementation of Clinical Programs’ strategy and goals and the oversight of Clinical Programs’ operations. The incumbent oversees the effective integration and continuous improvement of processes and systems to meet Premera’s current and future business goals. Responsibilities also include managing and developing a team of clinical and support staff promoting their professional growth and operational effectiveness.

What you’ll do:

• Participate in development of Clinical Programs’ strategy and planning in accordance with company’s mission and strategic goals, federal and state law and regulations, and accreditation standards.

• Assist in the selection, training, evaluation, and development of professional paraprofessional, and administrative team members.

• Lead Care Management teams in effective performance of job functions, which may include case management and delegated management oversight.

• Participate in the development and monitoring of budgets in accordance with department and organizational objectives.

• Participate in the development, implementation, and monitoring of the department’s performance standards, utilizing quality improvement methodologies to refine procedures.

• Foster collaborative work environment that encourages team building, facilitates cohesive synergetic performance of Case Management functions, while valuing the individual diversity and uniqueness of all employees.

• Build and maintain cooperative business relationships.

• Participate in activities and processes to ensure operational compliance with regulatory requirements, including NCQA and OIC.

• Provide effective oversight and developmental support for team members to meet productivity and satisfy expectations. Facilitate team building across the team so that team members feel connected to one another and the larger department.

• Effectively manages deficits with improvement plans and consistent follow-up.

• Use data effectively to monitor performance, identify opportunities and address problems and opportunities timely.

What You’ll Bring:

• Candidates with a RN License are highly preferred.

• Current state credential (e.g. licensure) that allows the professional to conduct an assessment independently as permitted within the discipline’s scope of practice (Required): For nurses, required registration (e.g. RN, ARNP). For behavioral health, required licensure (e.g. LMFT, LICSW, LPC, LMHC). For psychologist, required board certification. For dietitians, required certification as a nutritionist or dietician. Or licensure in related healthcare discipline.

• (Required) Certified in CCM (Certified Case Management) or obtain certification within 24 months of date of hire.

• (Required) Five (5) years case management or health care experience.

• (Required) Three (3) years management experience.

• Advanced degree such as Master’s Degree in a Health-Related field preferred.

• Experience with NCQA, URAC, or accreditation review processes.

• Experience in continuous process improvement and creative problem solving (e.g. LEAN, Synectic).

• Advanced training in Motivational Interviewing.

• Experience training clinical and non-clinical staff.

• Experience managing case management teams and integrated case management model.

Premera total rewards

Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Our total rewards are more than a collection of perks, they’re a reflection of our commitment to your health and well-being. We offer a broad array of rewards including physical, financial, emotional, and community benefits, including:

• Medical, vision, and dental coverage with low employee premiums.

• Voluntary benefit offerings, including pet insurance for paw parents.

• Life and disability insurance.

• Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service.

• Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few.

• Generous paid time off to reenergize.

• Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees.

• Employee recognition program to celebrate anniversaries, team accomplishments, and more.

For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.

• Commuter perks make your trip to work less impactful on the environment and your wallet.

• Free convenient on-site parking.

• Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.

• Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.

• Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.

• Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus.

Equal employment opportunity/affirmative action:

Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.

If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at [e-mail] or via phone at 425-918-4785.

Premera is hiring in the following states, with some limitations based on role or city:

Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin.

The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience.

The salary range for this role is posted below; we generally target up to and around the midpoint of the range.

National Salary Range:

$89,300.00 - $151,800.00

National Plus Salary Range:

$101,900.00 - $173,200.00

*National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska

We’re happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all. We’re committed to creating an environment where all employees are celebrated for their unique skills and contributions.