Remote RN Case Manager - Transform Care

Premera Blue Cross; Texas; Remote; USD 81,000 - 157,000; Full time

Job summary

Premera Blue Cross is seeking a qualified Case Manager to support members through a whole-person care model in a telecommuter role. You will conduct holistic assessments, identify social determinants of health, and collaborate with caregivers and providers to develop member-centric plans that lead to improved health outcomes.

Required licensure (WA State or Compact) and post-licensure experience, plus strong case management and motivational interviewing skills.

Qualifications

• Active WA State or Compact RN or ARNP license that allows independent assessment.
• 3 years' post licensure direct care experience.
• 1 year of post-licensure case management experience involving care coordination, care planning, discharge planning, or management of patient care over time.
• Certified Case Manager (CCM) certification; if not held at hire, must obtain within 24 months.
• 4+ years direct care experience across multiple patient populations, conditions, or care settings.
• Motivational interviewing experience.
• Chronic Condition Certifications (Asthma, Cardiology, Diabetes, High Risk Maternity, Oncology, Pediatrics).
• Integrated Case Management certificate (ICM).
• Chemical Dependency Professional (CDP) certification.
• LEAN training.

Responsibilities

• Engage members who are facing medical utilization disorders and build a relationship that will support open and constructive dialog on sensitive topics.
• Conduct initial holistic health assessments that help build an understanding of a member’s specific situation and needs and identify any social determinants of health (SDOH) and cultural influences that may impact potential lifestyle changes.
• Create a space where a case manager and member can collaborate, along with relevant caregivers and providers, to develop a member‑centric case management plan that sets goals, addresses potential barriers, and leads to improved health outcomes.
• Monitor, evaluate, and update the effectiveness of the member's case management plan to ensure progress toward goals is being made and that current goals remain pertinent.
• Facilitate communication and coordination among the health care team to maximize delivery of appropriate care.
• Provide interventions focused on removing barriers, promoting positive behavior change using motivational interviewing techniques, and stabilizing the members’ natural support systems by ensuring that caregiver needs are identified and being met.
• Maintain concise, accurate, and timely documentation that meets accreditation, contractual, and legal requirements.

Skills

Motivational interviewing

Care coordination

Discharge planning

Education

Bachelor’s or Master’s degree

Job description

Premera Blue Cross is seeking a qualified Case Manager to support members through a whole-person care model in a telecommuter role. You will conduct holistic assessments, identify social determinants of health, and collaborate with caregivers and providers to develop member-centric plans that lead to improved health outcomes.

Required licensure (WA State or Compact) and post-licensure experience, plus strong case management and motivational interviewing skills.