RN Case Manager

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.

Deploy corporate strategy for supporting members in obtaining best-fit care within immediate health care system and other supporting services while promoting access to evidenced based care. Educate, empower, and coordinate services for members to improve members’ well-being and moderate claims trends. Facilitate communication between identified care team members including but not limited to members and or their appointed representatives, providers, community-based organizations, and the health plan to ensure members receive the full benefit of integrated care.

Manage members through evidence-based care, promote access to healthcare system, and assess needs to identify appropriate interventions. Member management includes, but is not limited to, the conduction of health assessments (telephonic and face-to-face) to identify high-risk or emerging risk members for education and intervention and the evaluation and modification of action plans by working with members and collaborating with providers. Evaluate member services to ensure appropriate levels and coordination of care, including pre-authorization, concurrent review, quality-of-care screening, and discharge planning. Ensure member and provider satisfaction by demonstrating knowledge of member plan benefits and community resources. Identify opportunities to moderate claims costs for the employer group and individual members. Promote and monitor the use of wraparound service programs for optimal member experience while managing chronic and acute care needs. Facilitate communication between members, providers, and stakeholders to coordinate and implement action plans for improving members’ total health. Provide continuity and consistency of care by building positive relationships between members, families, providers, care coordinators, and the health plan. Engage in team operations including supervision, team huddles, staff meetings, case rounds, metric management, training opportunities, department initiatives, and projects. Work collaboratively to develop and implement solutions, identify barriers, and exemplify corporate values through accountability, collaboration, integrity, and respect.