RN Case Management Leader: Drive Quality & Growth

Blue Cross and Blue Shield of Massachusetts, Inc.; Hingham (MA); On-site; USD 105,000 - 128,000; Full time

Benefits offered by this job

Benefits package

401(k)

Paid time off

Job summary

Blue Cross Blue Shield of Massachusetts, Inc. in Hingham is seeking an RN Manager to lead the case management and utilization management team, overseeing operations, policy execution and staff development.

You will monitor group metrics, ensure quality improvements, and mentor CM/UM staff while collaborating with clinical and non-clinical partners to optimize member care. The role requires MA RN licensure, BSN, 3–5 years of RN supervisory experience, and strong communication, negotiation and IT

Qualifications

• Active licensure in Massachusetts is required, appropriate to position (RN, PT, CCM, LICSW, LMHC, BCBA).
• For Registered Nurses Only: A Bachelor's degree in nursing (BSN) is required; Master's degree, preferred.
• Minimum 3-5 years of RN supervisory and/or management experience, desirable.
• Knowledge in the case management/ utilization management process, programs, services, business implications, trends, and policies.
• Critical thinking & problem-solving skills.
• Adaptability, flexibility, and self-discipline.
• Exceptional communication, writing, presentation, and negotiation skills.
• Proficiency with Information Technology systems.
• Bilingual, a plus.

Responsibilities

• Implement strategic and operational goals for the CM/UM group; implement and monitor supporting plans.
• Oversee the CM/UM group, providing group communications and issue escalation / resolution support.
• Maintain awareness, attitude, knowledge, and skills to work effectively with a culturally and demographically diverse population.
• Serve as a mentor and advisor to CM and UM's as they work through complex or particularly unique cases.
• Become an expert of BCBSMA's products, benefits, healthcare delivery system, accreditation, regulatory requirements, and community resources.
• Interpret, evaluate, and clearly document complex medical information using a directive and focused approach in order to identify relevant and actionable conditions, circumstances, and behaviors.
• Meet deadlines, and deliver expected outcomes with appropriate sense of urgency.
• Build effective relationships internally and externally, in person and virtually, in order to facilitate professional and business goals.
• Effectively negotiate clinical operations environment; Manages clinical and non-clinical resources effectively (e.g., cost, productivity).
• Maintain knowledge of all clinical areas and specific member population.
• Responsible for staff management and development including, recruiting and rewarding staff, setting performance expectations, and assessing, monitoring, and counseling staff regarding individual performance.
• Articulate performance expectations and establish ongoing training programs for case management associates to achieve these expectations.
• Provide management and direction to ad-hoc projects requested by senior management.
• Track, analyze, interpret, and report regularly to leadership on case management group performance metrics.
• Conduct audits to ensure productivity and performance are meeting or exceeding performance expectations; implement plans to address performance gaps.
• Adherence to program, departmental and organizational performance metrics.
• Foster clinical excellence by promoting and participating in educational opportunities.

Skills

RN leadership

Management

Negotiation

Communication

Problem solving

Adaptability

IT proficiency

Mentoring

Team building

Education

BSN required

MSN preferred

Massachusetts RN license

Tools

Information Technology systems

EMR systems

Job description

Blue Cross Blue Shield of Massachusetts, Inc. in Hingham is seeking an RN Manager to lead the case management and utilization management team, overseeing operations, policy execution and staff development.

You will monitor group metrics, ensure quality improvements, and mentor CM/UM staff while collaborating with clinical and non-clinical partners to optimize member care. The role requires MA RN licensure, BSN, 3–5 years of RN supervisory experience, and strong communication, negotiation and IT