Senior Care Management Leader (Remote/Hybrid)

Blue Cross & Blue Shield of Rhode Island; Providence (RI); Híbrido; USD 94.000 - 140.000; Jornada completa

Descripción de la vacante

Blue Cross & Blue Shield of Rhode Island is seeking a Manager of Care Management to oversee daily department operations, develop and maintain care management programs, and ensure alignment with regulatory standards. You will lead a team, collaborate with utilization review and clinical services, monitor budgets, and drive process improvements to support members and Rhode Island communities.

A RN license and bachelor's degree are required.

Formación

• Bachelor’s degree in Nursing or related field and active RN license
• Five to seven years in utilization review, case management, and/or disease management
• Three to five years of management experience or leading a team
• Knowledge of managed benefits strategies, utilization review techniques, and healthcare administration
• Ability to coach, communicate goals, and manage projects
• Proficiency with Microsoft Office (Word, Excel, PPT)

Responsabilidades

• Manage daily operations of the Care Management department.
• Develop, implement, and maintain departmental policies and programs.
• Ensure case management services align with industry standards and company strategy.
• Monitor trends to keep programs innovative and aligned with goals.
• Assist with contract development to reflect medical management initiatives.
• Provide direction, guidance, and performance feedback to staff.
• Ensure regulatory compliance with NCQA, DOH, CMS, URAC, HIPAA, RI Workers Comp.

Descripción del empleo

Blue Cross & Blue Shield of Rhode Island is seeking a Manager of Care Management to oversee daily department operations, develop and maintain care management programs, and ensure alignment with regulatory standards. You will lead a team, collaborate with utilization review and clinical services, monitor budgets, and drive process improvements to support members and Rhode Island communities.

A RN license and bachelor's degree are required.