Complex Commercial RN Case Manager

RN Case Manager

Join our dedicated team as an RN Case Manager, where you will play a vital role in facilitating care for members and their families who face complex healthcare needs and increasing health risks. Your efforts will empower individuals to achieve optimal health outcomes.

This position is ideal for a self-motivated professional who thrives both independently and as part of a collaborative team. You will focus on assessing needs, identifying healthcare disparities, addressing social determinants of health, and overcoming barriers to care.

As part of a committed group of health professionals, including medical and behavioral health managers, dietitians, pharmacists, and clinicians, you will work together to ensure comprehensive care for our members.

This position can be fully remote, with the expectation of working in our office in Hingham, MA, once a month.

Key Responsibilities :

• Engage members in personalized care plans, coordinate services, and provide education and resources to enhance their treatment experience.
• Utilize case management criteria, processes, and regulatory standards to develop and document comprehensive care management plans effectively.
• Review complex medication regimens, educate members on potential side effects, and guide them through mitigation strategies.
• Maintain consistent member engagement to ensure seamless transitions of care and improved health outcomes.
• Collaborate with treatment providers including PCPs, physicians, and therapists to gather necessary clinical information.
• Identify and escalate any clinical quality concerns, ensuring members receive the highest quality of care.
• Understand member insurance products, benefits, and regulatory requirements to navigate care effectively.

Key Qualifications :

Education and Experience :

Blue Cross Blue Shield of Massachusetts values diversity and is an Equal Employment Employer, providing opportunities regardless of race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or expression. We encourage applicants from all backgrounds to apply.

Location : Hingham

Time Type : Full-time

Weekly Hours : 37.5

Salary Range : $42.78 - $52.29 per hour. This position is also eligible for variable pay.

Our comprehensive benefits package includes paid time off, medical / dental / vision insurance, 401(k), and various well-being benefits for eligible employees.

At Blue Cross Blue Shield of MA, we recognize that many qualified candidates may hesitate to apply due to confidence gaps or imposter syndrome. We encourage you to reach out—your unique experiences and perspectives may be exactly what we need! Your contributions and diverse voice will help us transform healthcare for all.

We are devoted to supporting your development and success, fostering an inclusive and rewarding workplace where you can thrive.