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$74k–$110k/yr
Full-time
professional certificate
Flexible Work Arrangements, Remote and Hybrid Opportunities, Paid Time Off, Tuition Reimbursement, Student-loan Repayment, Health Insurance
Posted 42d ago
~40 hrs/week
Responsibilities
Direct and coordinate care for D-SNP beneficiaries by completing health risk assessments and developing individualized care plans. Collaborate with providers and interdisciplinary teams to facilitate communication and implement interventions to improve member health outcomes.
Requirements
Requires an active RN license and three to five years of experience in a clinical environment or managed health plan. Candidates must have expertise with D-SNP beneficiaries and obtain CCM certification within three years of employment.
Full job description
Pay Range:
$73,600.00 - $110,400.00
Please email [email protected] if you are a candidate seeking a reasonable accommodation for the application and/or interview process.
At BCBSRI, our greatest resource is our people.
We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do—not just for our members, but for our employees as well.
We recognize that to do your best work, you have to be your best self. It’s why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees.
Our culture is one of belonging. We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you’re at in the organization, you’re an integral part of our team and your input, thoughts, and ideas are valued.
Join others who value a workplace for all. We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders.
We’re dedicated to serving Rhode Islanders. Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state—building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer.
Why this job matters:
Direct and coordinate the beneficiary’s care. Complete the HRA with the D-SNP member and/or the comprehensive assessment, coordinate care across the health care continuum, coordinating benefits, managing the members of the ICT, and developing and maintaining the ICP. Responsible for taking the problems/barriers from the HRA and incorporating into the ICP. Educate the beneficiary and/or caregiver on self-management strategies and skills. Collaborate with other team members, providers, community agencies and caregivers/ natural supports to facilitate the development of the ICP. Work closely with the health navigator to support self-management activities and the associated SMART goals. Facilitate communication among the beneficiary, providers, health plan, and others who participate in the beneficiary’s care. Provide consultation and support to the Behavioral Health Care Manager and other members of the ICT to support integrated care management delivery
What you will 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 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 department initiatives and projects. Perform other duties as assigned.
What you need to succeed:
A combination of education and related work experience
Active and unrestricted RN license issued by a state participating in the Nurse Licensure Compact (NLC)
Three to five years’ experience in a medical/clinical environment or managed health plan
Expertise working with D-SNP beneficiaries
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
The extras:
Professional nursing certification
Experience working in a managed care/health maintenance organization
Bilingual preferred
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
Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today’s healthcare industry. BCBSRI is an equal opportunity employer.
A nonprofit health insurer helping all Rhode Islanders live their healthiest lives.
Industry
Insurance
Company size
501-1,000 employees
Founded
1939
Headquarters
Providence, Rhode Island
LinkedIn followers
20,690
At Blue Cross & Blue Shield of Rhode Island (BCBSRI), we know that health is more than what happens at the doctor’s office. Our vision is to improve health and well-being by leading access to high-quality, affordable, and equitable care. That means focusing on innovation, from opening retail stores across the state to expanding access to behavioral health services to helping address food insecurity among our neighbors.
BCBSRI is connected nationwide as an organization of 33 independent Blues plans, working locally and together to transform care from the ground up and serve members wherever they are. Whether you're an individual looking to join our team or an employer looking to protect your employees' health, let's work together to make a difference.
BCBSRI is an independent licensee of the Blue Cross and Blue Shield Association.
Offices: 500 Exchange Street, Providence, Rhode Island 02903, US
How many Management & Leadership jobs are open in Providence, RI right now?
There are currently 355 open management & leadership positions in Providence, RI listed on Clera. New openings are added daily as companies post roles.
Which companies are hiring for Management & Leadership roles in Providence, RI?
Companies currently hiring include Care New England, Domino's, Johnson & Wales University (JWU) - North Miami, Blue Cross & Blue Shield of Rhode Island, Family Service of Rhode Island, among others. Browse the listings above to see every active employer.
Are there remote or hybrid Management & Leadership jobs in Providence, RI?
Yes — 106 of the 355 open management & leadership positions offer remote or hybrid work (40 remote, 66 hybrid).
How do I apply for Management & Leadership jobs in Providence, RI?
Each listing links directly to the employer's application page. Apply early — fresh listings get the most recruiter attention in the first two weeks.