Pay Range:
$93,600.00 - $140,400.00
Please email if you are a candidate seeking a reasonable accommodation for the application and/or interview process.
Must reside within a commutable distance (RI,MA,CT).
Why this job matters:
Manage daily operations of department. Manage the development, implementation, and maintenance of departmental policies, procedures and programs. Ensure the delivery of case management services are aligned with industry standards, best practices, and the company’s strategy. Monitor industry trends to ensure case management programs are innovative and designed to meet the company’s goals.
What you will do:
- Manage case management programs to ensure the delivery of services is aligned with the company’s goals.
- Develop programs to ensure collaboration between utilization and case management are maximized to achieve departmental objectives.
- Conduct evaluations of programs to determine effectiveness of programs and need to modify or eliminate.
- Make recommendations for improvements of case management programs to the department’s leadership team.
- Monitor department expenses on a regular basis to ensure budget targets are achieved.
- Ensure department complies with all applicable regulatory guidelines including NCQA, DOH, CMS, URAC, HIPAA, State of RI Workers Comp Protocol. DOL.
- Assist with contract development and implementation to ensure contracts reflect medical management initiatives, processes, and regulatory requirements.
- Provide direction and guidance to staff. Set goals, review and evaluate work, and prepare performance reviews.
- Provide technical guidance to staff.
- Perform other duties as assigned.
What you need to succeed:
- Bachelor’s degree in Nursing or related field, or an equivalent combination of education and experience with active and unrestricted RN license issued by a state participating in the Nurse Licensure Compact (NLC)
- Five to seven years experience in utilization review, case management, and/or disease management and up to five years clinical nursing or other related applicable experience
- Three to five years management experience or experience leading a team
- Knowledge of managed benefits strategies, utilization review techniques, health care financing and delivery, program development, care management, quality management, and health care administration
- Knowledge of evidence based clinical practice
- Ability to coach and motivate to maximize performance
- Ability to effectively communicate goals and business objectives to employees
- Strong and effective decision-making skills
- Strong organization and time management skills
- Proficiency with Microsoft Suite of products (i.e., Word, Excel, PPT, etc.)
- Ability to effectively interact with all levels of the organization
- Ability to effectively delegate work and manage project tasks
- Excellent verbal and written communication skills, with ability to convey complex or technical information in an effective manner
The extras:
- Possession and maintenance of Case Management Certification (CCM) within three (3) years tenure in the position.
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
