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Job Description

Schedule: In-office, hybrid Jump into the new world of health insurance:At Blue Cross & Blue Shield of Rhode Island (BCBSRI), our business is healthcare. But our focus is on improving lives. Be part of a team that’s large enough to make a difference but small enough to be innovative. Work in a rapidly changing field. Take a chance to be creative. Move outside the status quo. Shape new ideas with the power of a national brand behind you.Join others who know diversity is strength: We appreciate and celebrate everything that makes us unique: age, national origin, citizenship status, perspectives, experiences, physical or mental disability, military status, race, ethnicity, religion, gender, sexual orientation, gender identity and/or expression. Our diversity strengthens us as an organization and helps us better serve an increasingly diverse Rhode Island population.Why this job matters:You will assist members in navigating the health care system, ensuring access to evidenced based care.  You will educate, empower, and coordinate services for members to improve their health and well being. You will facilitate communication between patient, provider, and health plan to ensure members receive the full benefit of integrated care.What you’ll do:Manage members through the healthcare delivery system; assess needs in order to identify appropriate interventions. Conduct telephonic or face to face health assessments to identify high risk or emerging risk members who would benefit from education and intervention.Facilitate communication between members, providers, and stakeholders to coordinate and implement action plans aimed at improving the members’ total health.Identify opportunities to impact claims expense trends for the all lines of business/or at the individual member levelEvaluate action plans by working with members and collaborating with providers.  Modify action plans as necessaryMonitor and evaluate patient services to ensure appropriate coordination of careCollaborate with the Utilization Review process including pre-authorization, concurrent review, screening cases for quality of care issues, and discharge planningPromote member and provider satisfaction by demonstrating working knowledge of member benefits, including but not limited to health, disability, Employee Assistance or other plans/benefits available to the member.Provide continuity and consistency of care by building positive relationships between the member and family, physicians, provider, care coordinator, and health care planWork collaboratively with the team and others necessary to develop and implement solutions Identify barriers to performing job duties as well as opportunities for improvements Exemplifying the corporate values in action through accountability, collaboration, integrity and respect in maintaining a high-performance cultureParticipate in department initiatives and projectsPerform other duties as assignedKnowledge of utilization management and/or coordination of careKnowledge of population health and chronic condition management principlesUnderstanding of health care delivery system access points and servicesAbility to navigate the healthcare delivery systemGood business acumenKnowledge of business process improvement techniques and strategiesExcellent verbal, written communications, and technical skillsNegotiation skillsPresentation skillsDecision-making skillsGood problem-solving skillsAbility to interface with employees at all levelsAbility to effectively navigate ambiguous situations with limited directionExcellent organizational skills and ability to successfully prioritize multiple tasksAbility to handle multiple priorities/projectsStrong time management skillsWhat you need to succeed:Combinations of education and experienceUnrestricted Rhode Island Nursing License and Unrestricted Massachusetts Nursing License, or unrestricted Registered Dietician LicenseThree to five years experience in a medical/clinical environment or managed health planMust obtain Certified Case Manager (CCM) certification within three years of employment*Applies to positions working with FEP product onlyThe extras:Bachelor’s Degree in NursingProfessional nursing certification (multiple states preferred)Experience working in a managed care/health maintenance organizationExperience with chronic condition management, specifically diabetesAbility to speak multiple languages (bilingual)Location:BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role:In-office: onsite 5 days per weekHybrid: onsite 2-4 days per weekRemote: onsite 0-1 days per week Permitted to reside in the following states, pending approval from the Human Resources Department:   Arizona, Connecticut, Florida, Georgia, Louisiana, Maine, Massachusetts, Nevada, New Hampshire, North Carolina, Pennsylvania, Rhode Island, South Carolina, Texas, Virginia.  Other important information:Blue Cross & Blue Shield of Rhode Island has a COVID-19 vaccination requirement for all associates. Offers of employment are contingent on being fully vaccinated for COVID-19 or through an approved accommodation request for either a medical or religious exemption. Requests for accommodations can be made to a representative in the human resources department upon receiving an offer.

Company Overview

  • Website bcbsri.com
  • Headquarters PROVIDENCE, RI
  • Size 1,000 - 3,000
  • Founded 1939
  • Type NGO/NPO/NFP/Organization/Association
  • CEO KIM KECK
  • Revenue $500M - $1B
  • Industry Insurance
  • About blue cross & blue shield of rhode island

Skills for Case Manager (DSNP)

The job skills required for Case Manager (DSNP) include Health care, Problem Solving, Collaboration, Written Communication, Time Management,and Health insurance etc. Having related job skills and expertise will give you an advantage when applying to be a Case Manager (DSNP). That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Case Manager (DSNP). Select any job title you are interested in and start to search job requirements.

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Career Path for Case Manager (DSNP)

The following is the career advancement route for Case Manager (DSNP) positions, which can be used as a reference in future career path planning. As a Case Manager (DSNP), it can be promoted into senior positions as a Case Management Director that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Case Manager (DSNP). You can explore the career advancement for a Case Manager (DSNP) below and select your interested title to get hiring information.