The Role The Direct Care Clinical Care Manager is responsible for facilitating and delivering care to members to increase access to care and improve clinical outcomes. This position is self-directed and works collaboratively to close identified gaps in care, focusing on preventive screenings, management of chronic disease, and facilitating necessary follow-up care.
The Team The Direct Care Clinical Care Manager is part of a dedicated team of professionals, including medical and behavioral health care managers, dieticians, pharmacists, clinicians, and medical directors, all collaborating to facilitate clinically appropriate quality care.
Key Responsibilities - Conduct telehealth visits by video and phone with BCBSMA members, with varying volume each week and likely daily visits.
- Chronic disease management for Medicare-age members, specifically hypertension and diabetes via remote workflows.
- Creatively co-design an innovative virtual care program, including workflows and clinical protocols with Medical Director support for expanding clinical scope.
- Effective use of electronic medical record workflows and documentation.
- Engage members in appropriate plans of care, coordinate care and services as appropriate, communicate effectively, and provide members with education and resources as needed.
- Promote member compliance with treatment plan, encourage shared decision-making, and set appropriate goals to promote optimal member outcomes.
- Interpret and apply case management criteria, processes, policies, and regulatory standards to create, follow and appropriately document comprehensive care management plans.
- Review medication list and educate members with complex pharmacy needs, and counsel on side effects and mitigation strategies for specific treatment protocols.
- Successfully connect, engage, and maintain member engagement to support seamless care transitions and optimized health outcomes.
- Collaborate with treatment providers, PCPs, physicians, therapists, and facilities as needed to gather clinical information to support the plan of care.
- Monitor clinical quality concerns, make referrals appropriately, identify and escalate quality of care issues.
- Understand BCBSMA products and benefits, as well as regulatory and NCQA requirements
Key Qualifications - Ability to identify and document member-driven, specific, measurable activities that address actionable behaviors and goals
- Self-directed, independent, adaptive, flexible to change, and able to collaborate as a member of a team.
- Proficient with multiple IT systems.
- Demonstration of awareness, attitude, knowledge, and skills needed to work effectively with a culturally and demographically diverse population.
Education and Experience - Currently licensed as an NP in Massachusetts with 3-5 years recent experience in care delivery and willing to continue clinical practice.
- Ideally 10+ years' experience in ambulatory care, preferably as primary care provider for a population of patients.
- Proven abilities in patient engagement and relationship management.
Minimum Education Requirements:High school degree or equivalent required unless otherwise noted above
LocationBoston, Hingham
Time TypeFull time
Salary Range: $115,200.00 - $140,800.00
The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.
This job is also eligible for variable pay.
We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.
Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.
