RN Case Manager: Care Coordinator for Members

Excellus BlueCross BlueShield; Town of De Witt (NY); On-site; USD 62,000 - 118,000; Full time

Job summary

Excellus BlueCross BlueShield is seeking a Case Management professional to conduct program activities in alignment with CMSA, NCQA, NYS DOH, CMS, FEP and NCQA accreditation standards. You will assess member needs, educate and support, and coordinate with providers and community resources to optimize outcomes.

Collaborates with interdisciplinary teams to create comprehensive care plans, identifies opportunities to educate and coach members, and ensures cost-effective, high-quality care across the

Qualifications

• Associates degree required; Bachelor’s degree preferred.
• Active NYS RN or Registered Dietician or Physical Therapist licensure required.
• Minimum of three years of clinical experience; Case Management experience preferred.
• Proficiency with the Microsoft Office Suite.
• Experience interpreting managed care benefit plans and government program contracts (Medicare/Medicaid) preferred.
• Strong written and verbal communication skills.
• Ability to multitask and balance priorities.
• Ability to work independently on a daily basis.

Responsibilities

• Handles Level I–III member clinical management programs.
• Maintains knowledge of CMSA, NCQA standards, and applicable regulations.
• Implements and coordinates case management processes from identification to case closure.
• Collaborates with providers and community resources to develop comprehensive care plans.
• Assists in education and engagement of members and families.
• Participates in cross-functional teams to improve care quality and cost outcomes.

Skills

Multitasking

Communication

Independent work

Education

NYS RN licensure

NYS Registered Dietician licensure

NYS Physical Therapist licensure

Tools

Microsoft Office Suite

Job description

Excellus BlueCross BlueShield is seeking a Case Management professional to conduct program activities in alignment with CMSA, NCQA, NYS DOH, CMS, FEP and NCQA accreditation standards. You will assess member needs, educate and support, and coordinate with providers and community resources to optimize outcomes.

Collaborates with interdisciplinary teams to create comprehensive care plans, identifies opportunities to educate and coach members, and ensures cost-effective, high-quality care across the