Manager of Care Management

Blue Cross & Blue Shield of Rhode Island; United States; Hybrid; USD 94,000 - 140,000; Full time

Benefits offered by this job

Tuition reimbursement

Student-loan repayment assistance

Health, dental, and vision insurance

Paid time off

Job summary

Blue Cross & Blue Shield of Rhode Island is seeking a leader to manage daily operations of the Case Management department, aligning programs with industry standards and the company’s strategy. This role ensures the delivery of high-quality case management and utilization review services.

Ideal candidates will have a nursing background with an active RN license and 5–7 years in utilization review or case management, plus 3–5 years of managerial experience.

Qualifications

• Bachelor's degree in Nursing or related field with active RN license.
• Five to seven years of experience in utilization review, case management and/or disease management.
• Three to five years of management experience or leading a team.
• Knowledge of managed benefits strategies and health care delivery.
• Strong communication and leadership abilities.

Responsibilities

• Manage daily operations of the department and develop/maintain policies and programs.
• Oversee case management to align with company goals and regulatory standards.
• Evaluate programs for effectiveness and implement improvements.
• Manage department budget and ensure regulatory compliance (NCQA, DOH, CMS, URAC, HIPAA).
• Provide guidance, set goals, and perform staff performance reviews.

Skills

Utilization review

Case management

Disease management

Team leadership

Communication

Microsoft Office

Education

Bachelor's degree in Nursing or related field

Active RN license (NLC)

Job description

Pay Range: $93,600.00 - $140,400.00 Please email [e-mail] if you are a candidate seeking a reasonable accommodation for the application and/or interview process.

At BCBSRI, our greatest resource is our people. We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do- not just for our members, but for our employees as well. We recognize that to do your best work, you have to be your best self. It's why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees. Our culture is one of belonging. We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you're at in the organization, you're an integral part of our team and your input, thoughts, and ideas are valued. Join others who value a workplace for all. We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders. We're dedicated to serving Rhode Islanders. Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state-building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer.

Must reside within a commutable distance (RI,MA,CT).

Why this job matters:

Manage daily operations of department. Manage the development, implementation, and maintenance of departmental policies, procedures and programs. Ensure the delivery of case management services are aligned with industry standards, best practices, and the company’s strategy. Monitor industry trends to ensure case management programs are innovative and designed to meet the company’s goals.

What you will do:

Manage case management programs to ensure the delivery of services is aligned with the company’s goals. Develop programs to ensure collaboration between utilization and case management are maximized to achieve departmental objectives. Conduct evaluations of programs to determine effectiveness of programs and need to modify or eliminate. Make recommendations for improvements of case management programs to the department’s leadership team. Monitor department expenses on a regular basis to ensure budget targets are achieved. Ensure department complies with all applicable regulatory guidelines including NCQA, DOH, CMS, URAC, HIPAA, State of RI Workers Comp Protocol. DOL. Assist with contract development and implementation to ensure contracts reflect medical management initiatives, processes, and regulatory requirements. Provide direction and guidance to staff. Set goals, review and evaluate work, and prepare performance reviews. Provide technical guidance to staff. Perform other duties as assigned.

What you need to succeed:

Bachelor's degree in Nursing or related field, or an equivalent combination of education and experience with active and unrestricted RN license issued by a state participating in the Nurse Licensure Compact (NLC) Five to seven years experience in utilization review, case management, and/or disease management and up to five years clinical nursing or other related applicable experience Three to five years management experience or experience leading a team Knowledge of managed benefits strategies, utilization review techniques, health care financing and delivery, program development, care management, quality management, and health care administration Knowledge of evidence based clinical practice Ability to coach and motivate to maximize performance Ability to effectively communicate goals and business objectives to employees Strong and effective decision-making skills Strong organization and time management skills Proficiency with Microsoft Suite of products (i.e., Word, Excel, PPT, etc.) Ability to effectively interact with all levels of the organization Ability to effectively delegate work and manage project tasks Excellent verbal and written communication skills, with ability to convey complex or technical information in an effective manner

The extras:

Possession and maintenance of Case Management Certification (CCM) within three (3) years tenure in the position.

Location:

BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role: In-office: onsite 5 days per week Hybrid: onsite 2-4 days per week Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia

At BCBSRI, our greatest resource is our people. We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do- not just for our members, but for our employees as well. We recognize that to do your best work, you have to be your best self. It's why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees. Our culture is one of belonging. We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you're at in the organization, you're an integral part of our team and your input, thoughts, and ideas are valued. Join others who value a workplace for all. We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders. We're dedicated to serving Rhode Islanders. Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state-building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer.

BCBSRI is an equal opportunity employer. The law requires an employer to post notices describing the Federal laws. Please visit www.eeoc.gov/know-your-rights-workplace-discrimination-illegal to view the "Know Your Rights" poster.

Location:

BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role: In-office: onsite 5 days per week Hybrid: onsite 2-4 days per week Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia

Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today’s healthcare industry. BCBSRI is an equal opportunity employer. The law requires an employer to post notices describing the Federal laws. Please visit www.eeoc.gov/know-your-rights-workplace-discrimination-illegal to view the "Know Your Rights" poster.

BCBSRI is an equal opportunity employer. The law requires an employer to post notices describing the Federal laws. Please visit www.eeoc.gov/know-your-rights-workplace-discrimination-illegal to view the "Know Your Rights" poster.