RN Case Manager: Care Coordination & Outcomes

Excellus BCBS; City of Rochester (NY); On-site; USD 62,000 - 118,000; Full time

Benefits offered by this job

Remote work option

Job summary

Excellus BCBS is seeking a Case Manager to conduct program activities aligned with CMSA, NCQA, NYS DOH, CMS and NCQA accreditation standards. The role includes identifying members, educating and coordinating care with providers and community resources, and collaborating with interdisciplinary teams to create comprehensive care plans.

The position requires clinical experience, licensure where applicable, and strong communication skills.

Qualifications

• Associates degree required; bachelor’s degree preferred.
• Active NYS RN, RD, or PT licensure required.
• Minimum of three years of clinical experience; case management experience preferred.
• Proficient with Microsoft Office Suite.
• Knowledge of managed care contracts (Medicare/Medicaid) and benefits.
• Strong written and verbal communication skills.
• Ability to multitask and balance priorities.
• Ability to work independently on a daily basis.

Responsibilities

• Handle all member clinical management programs.
• Maintain knowledge of CMSA, NCQA, DOH standards and applicable regulations.
• Develop and implement case management processes and care plans.
• Collaborate with care team to coordinate services and monitor outcomes.
• Maintain confidentiality and regulatory compliance.
• Mentor junior staff and participate in staff orientation.
• Lead process improvement efforts within Case Management.

Skills

Written and verbal communication

Multitasking

Independent work

Collaboration

Education

Associate degree

Bachelor's degree preferred

NYS RN licensure

Registered Dietitian licensure

Physical Therapist licensure

Job description

Excellus BCBS is seeking a Case Manager to conduct program activities aligned with CMSA, NCQA, NYS DOH, CMS and NCQA accreditation standards. The role includes identifying members, educating and coordinating care with providers and community resources, and collaborating with interdisciplinary teams to create comprehensive care plans.

The position requires clinical experience, licensure where applicable, and strong communication skills.