Care Manager (Remote)

Purposethis role supports the Dual Special Needs Population DSNP in Maryland. Under minimal supervision, the Care Manager conducts thorough research and analysis of members medical and behavioral health needs along with the key drivers influencing healthcare utilization and costs. The Care Manager partners closely with members and the interdisciplinary care team to develop and implement person-centered plans of care that promote a positive member experience, improved health outcomes, and cost-effective service delivery. We are seeking a bilingual Care Manager to enhance communication, cultural responsiveness, and engagement with our diverse DSNP member population. This position is remote with the expectation that the selected candidate resides within the greater Baltimore metropolitan area. The incumbent will be required to attend periodic in-person meetings, training sessions, or other business-related activities at a CareFirst location.

Essential Functions -------------------

• Identifies members with acute complex medical and/or behavioral health conditions.
• Engages onsite and/or telephonically with member family and providers to develop a comprehensive plan of care to address the members needs at various stages along the care continuum.
• Identifies relevant CareFirst and community resources and facilitates program network and community referrals.
• Collaborates with member and the interdisciplinary care team to develop a comprehensive plan of care to identify key strategic interventions to address members medical, behavioral, and/or social determinant of health needs.
• Engages members and providers to review and clarify treatment plans ensuring alignment with medical benefits and policies to facilitate care between settings.
• Monitors, evaluates, and updates plan of care over time focused on members stabilization and ability to self-manage.
• Ensures member data is documented according to CareFirst application protocol and regulatory standards.

Qualifications ----------------

Education Level -----------------

• High School Diploma or GED

Licenses and Certifications ---------------------------

• Upon Hire Required
• RN - Registered Nurse - State Licensure And/or Compact State Licensure
• RN - Registered Nurse in MD, VA, or Washington DC

Experience ------------

• 5 years clinically related experience working in Care Management, Discharge Coordination, Home Health Utilization Review, Disease Management, or other direct patient care experience.

Preferred Qualifications -------------------------

• Bachelors degree in nursing
• CCMA, ACM, or other RN Board Certified certification in case management
• Previous experience with Medicare and/or Medicare Advantage patient populations with multiple co-morbidities, complex needs, social determinants of health, and/or barriers to care.
• Bilingual - fluent in Spanish
• Skilled in typing and working within various web-based platforms

Knowledge, Skills, and Abilities (KSAs) -----------------------------------------

• Knowledge of clinical standards of care and disease processes
• Ability to produce accurate and comprehensive work products with minimal direction
• Ability to triage immediate member health and safety risks
• Basic understanding of the strategic and financial goals of a healthcare system or payor organization
• Excellent verbal and written communication skills, along with telephonic and keyboarding skills necessary to assess, coordinate, and document services for members
• Knowledgeable of available community resources and programs
• Proficient in the use of web-based technology and Microsoft Office applications such as Word, Excel, and PowerPoint
• Ability to provide excellent internal and external customer service
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers within set expectations for service excellence

Salary Range --------------

• $72,216 - $143,429

Salary Range Disclaimer -------------------------

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as but not limited to the scope and responsibilities of the position, the candidates work experience, education, training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range as compensation decisions depend on each cases facts and circumstances, including but not limited to experience, internal equity, and location.

Equal Employment Opportunity -----------------------------

CareFirst BlueCross BlueShield is an Equal Opportunity EEO employer. It is the policy of the company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where to Apply ----------------

Please visit our website to apply: www.carefirst.com/careers

Federal Disclosure -------------------

The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

Physical Demand ----------------

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key, and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US ------------------

Must be eligible to work in the U.S. without sponsorship.