Care Manager (Hybrid)

PURPOSE :

Under minimal supervision, the Care Manager researches and analyzes a member's medical and behavioral health needs and healthcare cost drivers. The Care Manager works closely with members and the interdisciplinary care team to ensure members have an effective plan of care and positive member experience that leads to optimal health and cost-effective outcomes.

We are looking for an experienced professional in the Washington DC area who is willing and able to work in a hybrid model. The incumbent may be dedicated to a particular region or hospital system. The incumbent will be expected to work a portion of their week from home or other member / provider related location (such as a provider office or hospital system location) and a portion of their week at a CareFirst location based on business needs and work activities / deliverables that week. Must have a DC RN licensure.

ESSENTIAL FUNCTIONS :

Identifies members with acute / complex medical and / or behavioral health conditions. Engages onsite and / or telephonically with member, family and providers to develop a comprehensive plan of care to address the member’s needs at various stages along the care continuum. Identifies relevant CareFirst and community resources and facilitates program, network, and community referrals.

Collaborates with member and the interdisciplinary care team to develop a comprehensive plan of care to identify key strategic interventions to address member’s medical, behavioral and / or social determinant of health needs. Engage members and providers to review and clarify treatment plans ensuring alignment with medical benefits and policies to facilitate care between settings. Monitors, evaluates, and updates plan of care over time focused on member's stabilization and ability to self manage. Ensures member data is documented according to CareFirst application protocol and regulatory standards.

QUALIFICATIONS :

Education Level : High School Diploma or GED

Licenses and Certifications

• RN - Registered Nurse - State Licensure And / or Compact State Licensure RN- Registered Nurse in MD, and Washington, DC
• Accredited Case Manager (ACM) Federal Employee Program Book of Business (ONLY) : Must have CCM / ACM or other RN Board Certified certification in case management. Incumbents not certified at the time of hire must have two years of case management experience and meet requirements to take CCM or ACM exam and successfully achieve the certification within the first year of employment OR
• CCM - Certified Case Manager Federal Employee Program Book of Business (ONLY) : Must have CCM / ACM or other RN Board Certified certification in case management. Incumbents not certified at the time of hire must have two years of case management experience and meet requirements to take CCM or ACM exam and successfully achieve the certification within the first year of employment.

Experience : 5 years clinically related experience working in Care Management, Discharge Coordination, Home Health, Utilization Review, Disease Management or other direct patient care experience. See additional information below if Care Manager position is behavioral health focused.

Preferred Qualifications

Knowledge, Skills and Abilities (KSAs)

Additional Skills and Abilities

For Behavioral Health Care Managers, must have the following Education, Experience and License(s) :

level licensed behavioral health professional) :

Department

Department :

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.