RN Case Manager: Elevate Care & Outcomes

bcbsma; Hingham (MA); On-site; USD 56,000 - 68,000; Full time

Benefits offered by this job

PTO

Medical/dental/vision insurance

401(k)

Well-being benefits

Job summary

Blue Cross Blue Shield of Massachusetts is seeking a Clinical Care Manager to facilitate care for members with rising health risks or complex needs. You will assess needs, coordinate services, and educate members to promote optimal health in a self-directed, collaborative setting.

Role requires MA licensure (RN/LMHC/LICSW/LCSW) with 3–5 years of clinical experience; CCM/WELLCOACH certifications are a plus. Full-time position in Hingham, with a comprehensive benefits package.

Qualifications

• 3–5 years of relevant clinical health care experience (inpatient or outpatient).
• Case Management experience preferred.
• MA licensure required; RN/LMHC/LICSW/LCSW depending on role.
• Certifications such as CCM, Wellcoach are a plus.

Responsibilities

• Assess and evaluate member needs using strong communication, critical thinking, clinical knowledge, data and tools.
• Promote adherence to treatment plans and shared decision-making to improve outcomes.
• Apply case management criteria, processes and regulatory standards to create and document care plans.
• Review medication lists and educate on side effects and mitigation strategies.
• Engage and maintain member engagement for seamless care transitions and better outcomes.
• Collaborate with clinical team to provide high level care coordination.
• Interact with providers to gather clinical information to support the plan of care.
• Monitor quality concerns and identify opportunities for improvement.
• Understand member benefits and NCQA regulatory requirements.
• Identify cases for medical rounds and follow up with providers on recommendations.

Skills

Care coordination

Communication

Critical thinking

IT systems proficiency

Goal setting

Cultural competence

Learning agility

Team collaboration

Education

MA Licensure required (RN/LMHC/LICSW/LCSW)

BSN preferred

CCM certification a plus

Wellcoach certification a plus

Active licensure in additional states a plus

Job description

Blue Cross Blue Shield of Massachusetts is seeking a Clinical Care Manager to facilitate care for members with rising health risks or complex needs. You will assess needs, coordinate services, and educate members to promote optimal health in a self-directed, collaborative setting.

Role requires MA licensure (RN/LMHC/LICSW/LCSW) with 3–5 years of clinical experience; CCM/WELLCOACH certifications are a plus. Full-time position in Hingham, with a comprehensive benefits package.