Remote Case Management Lead

Premera Blue Cross; United States; On-site; USD 89,000 - 173,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

401K match

Pension plan

Tuition assistance

On-site parking (hybrid)

Wellness programs

Job summary

Premera Blue Cross in the United States is seeking a Manager, Case Management to lead and develop a team of clinical and support staff, oversee the execution of Clinical Programs’ strategy, and ensure effective integration of processes to meet current and future business goals with emphasis on quality, compliance, and outcomes.

You will foster a collaborative environment, guide budget development, use data to monitor performance, and promote professional growth while driving continuous

Qualifications

• RN license and current licensure to conduct assessments as required.
• CCM certification or the ability to obtain within 24 months.
• Five years of case management or health care experience.
• Three years of management experience.
• Experience with NCQA, URAC, or accreditation review processes.

Responsibilities

• Lead Care Management teams and oversee case management and delegated management oversight.
• Develop and monitor budgets aligned with department objectives.
• Implement performance standards using quality improvement methodologies.
• Foster collaboration and develop staff for growth and effectiveness.
• Ensure regulatory compliance with NCQA and related standards.

Skills

RN License

State licensure

CCM certification

Leadership

Team development

Quality improvement

Education

Advanced health-related degree

Master's preferred

Tools

NCQA/URAC experience

LEAN / process improvement

Job description

Premera Blue Cross in the United States is seeking a Manager, Case Management to lead and develop a team of clinical and support staff, oversee the execution of Clinical Programs’ strategy, and ensure effective integration of processes to meet current and future business goals with emphasis on quality, compliance, and outcomes.

You will foster a collaborative environment, guide budget development, use data to monitor performance, and promote professional growth while driving continuous