Senior RN Case Manager, Care Coordination

Excellus BCBS; United States; Remote; USD 62.000 - 117.000; Vollzeit

Zusammenfassung

Excellus BCBS seeks a skilled Case Management professional to oversee member care plans and collaborate with physicians and a multidisciplinary team. You will assess needs, educate members, and coordinate services to optimize health outcomes and cost efficiency.

Responsibilities include applying CMSA/NCQA standards, maintaining privacy, and advancing process improvements across levels I-III. Strong communication and independent work ethic are essential.

Qualifikationen

• Associates degree required; Bachelor’s preferred.
• Active NYS RN or Registered Dietician or Physical Therapist licensure required.
• Minimum of three years of clinical experience; Case Management experience preferred.
• Proficient with Microsoft Office Suite.
• Experience interpreting managed care benefit plans; strong knowledge of government program contracts.
• Strong written and verbal communication skills.
• Ability to multitask and balance priorities.
• Ability to work independently daily.
• Deliver efficient, seamless care to members.
• For FEP line: Case Management Certification within 2 years.
• For Hospital to Home: active NYS RN license with 3+ years behavioral health exp; LMSW/LCSW/LMHC may be required.

Aufgaben

• Handles member clinical management programs and ensures adherence to CMSA/NCQA standards.
• Maintains confidentiality and manages information per policy.
• Implements Case Management process from case identification to closure and reviews.
• Collaborates with providers and community resources to develop care plans.
• Engages in inter-disciplinary coordination to ensure quality care.
• Mentors staff and supports training opportunities.
• Leads in process improvement and covers escalations as needed.
• Ensures regulatory requirements (NYS DOH, CMS, NCQA, HEDIS) are met.

Kenntnisse

Clinical experience

Case management

NYS RN license

Registered Dietician license

Physical Therapist license

Communication skills

Multitasking

Independent work

Care delivery

Case Management Certification

Behavioral health experience

LMSW

LCSW

LMHC

Case management experience (2+ years)

Leadership potential

EMR / documentation

Performance metrics

5+ years CM

UM/CM knowledge

Staff training

Presentations

Ausbildung

Associates degree

Bachelor’s degree

Tools

Microsoft Office

Jobbeschreibung

Excellus BCBS seeks a skilled Case Management professional to oversee member care plans and collaborate with physicians and a multidisciplinary team. You will assess needs, educate members, and coordinate services to optimize health outcomes and cost efficiency.

Responsibilities include applying CMSA/NCQA standards, maintaining privacy, and advancing process improvements across levels I-III. Strong communication and independent work ethic are essential.