Pay Range:

Please email  if you are a candidate seeking a reasonable accommodation for the application and/or interview process.

Why this job matters:

Assist members in navigating the behavioral healthcare system, ensuring access to evidence-based care. Educate, empower, and coordinate services for members to improve their health and well-being. Facilitate communication between patient, provider, and health plan to ensure members receive the full benefit of integrated care.

What you will do:

• Manage members through the behavioral 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 all lines of business/or at the individual member level.
• Evaluate action plans by working with members and collaborating with providers.  Modify action plans as necessary.
• Monitor and evaluate patient services to ensure appropriate coordination of care.  Collaborate with the Utilization Review process including pre-authorization, concurrent review, screening cases for quality-of-care issues, and discharge planning.  .
• Promote 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 plan.
• Work 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 culture.
• Participate in weekly on-site initiatives at local MH and SUD facilities.
• Participate in department initiatives and projects.
• Perform other duties as assigned.

What you need to succeed:

• Active and unrestricted RN license issued by a state participating in the Nurse Licensure Compact (NLC), or licensed psychologist (doctoral level), Licensed Mental Health Counselor (LMHC) or licensed independent clinical social worker (LICSW). 
• Three to five years’ experience in a medical/clinical environment or managed health plan
• Must obtain Certified Case Manager (CCM) certification within three years of employment*
• Knowledge of utilization management and/or coordination of care
• Knowledge of population health and chronic condition management principles
• Understanding of health care delivery system access points and services
• Ability to navigate the healthcare delivery system
• Good business acumen
• Knowledge of business process improvement techniques and strategies
• Excellent verbal, written communications and technical skills
• Negotiation skills
• Presentation skills
• Decision-making skills
• Good problem-solving skills
• Ability to interface with employees at all levels
• Ability to effectively navigate ambiguous situations with limited direction
• Excellent organizational skills and ability to successfully prioritize multiple tasks
• Ability to handle multiple priorities/projects
• Strong time management skills

*Applies to positions working with FEP product only

The extras:

• Experience working in a managed care/health maintenance organization
• Experience in specialties such as pediatrics, adolescents, and geriatrics.
• Knowledge of healthcare plans and benefits.

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 week
• Hybrid: onsite 2-4 days per week
• Remote: 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, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia