Case Manager - Behavioral Health
Blue Cross & Blue Shield of Rhode Island, Providence, RI, United States
Pay Range
$73,600.00 - $110,400.00
Contact for Accommodation
Please email HR_Talent_AcquisitionTeam@bcbsri.org if you need a reasonable accommodation for the application or interview process.
Why This Job Matters
Assist members in navigating the behavioral healthcare system, ensuring access to evidence‑based care. Educate, empower, and coordinate services for members to improve their health and well‑being. Facilitate communication between patient, provider, and health plan to ensure members receive the full benefit of integrated care.
Responsibilities
Hybrid role requiring in‑person and community assessments.
Manage members through the behavioral healthcare delivery system; assess needs 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 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 improvement. Exemplify 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.
Qualifications
Active and unrestricted Rhode Island LMHC or LICSW.
Three to five years’ experience in a medical/clinical environment or managed health plan.
Must obtain Certified Case Manager (CCM) certification within three years of employment.
Applies only to positions working with FEP product.
Experience working in a managed care/health maintenance organization.
Experience in specialties such as pediatrics, adolescents, and geriatrics.
Knowledge of healthcare plans and benefits.
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, and technical communication 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 prioritize multiple tasks.
Strong time‑management skills.
Benefits & Work Arrangement
• Flexible work arrangements including remote and hybrid options.
• Paid time off and tuition reimbursement.
• Health, dental, and vision insurance.
• Employee well‑being programs and paid volunteer time.
Location & Schedule
BCBSRI is headquartered in downtown Providence, Rhode Island.
Scheduling options:
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: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia.
Equal Opportunity Employer
BCBSRI is an equal‑opportunity employer. The law requires an employer to post notices describing the Federal laws. Please visit www.eeoc.gov/know-your-rights-workplace-discrimination-illegal to view the "Know Your Rights" poster.
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$73,600.00 - $110,400.00
Contact for Accommodation
Please email HR_Talent_AcquisitionTeam@bcbsri.org if you need a reasonable accommodation for the application or interview process.
Why This Job Matters
Assist members in navigating the behavioral healthcare system, ensuring access to evidence‑based care. Educate, empower, and coordinate services for members to improve their health and well‑being. Facilitate communication between patient, provider, and health plan to ensure members receive the full benefit of integrated care.
Responsibilities
Hybrid role requiring in‑person and community assessments.
Manage members through the behavioral healthcare delivery system; assess needs 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 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 improvement. Exemplify 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.
Qualifications
Active and unrestricted Rhode Island LMHC or LICSW.
Three to five years’ experience in a medical/clinical environment or managed health plan.
Must obtain Certified Case Manager (CCM) certification within three years of employment.
Applies only to positions working with FEP product.
Experience working in a managed care/health maintenance organization.
Experience in specialties such as pediatrics, adolescents, and geriatrics.
Knowledge of healthcare plans and benefits.
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, and technical communication 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 prioritize multiple tasks.
Strong time‑management skills.
Benefits & Work Arrangement
• Flexible work arrangements including remote and hybrid options.
• Paid time off and tuition reimbursement.
• Health, dental, and vision insurance.
• Employee well‑being programs and paid volunteer time.
Location & Schedule
BCBSRI is headquartered in downtown Providence, Rhode Island.
Scheduling options:
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: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia.
Equal Opportunity Employer
BCBSRI is an equal‑opportunity employer. The law requires an employer to post notices describing the Federal laws. Please visit www.eeoc.gov/know-your-rights-workplace-discrimination-illegal to view the "Know Your Rights" poster.
#J-18808-Ljbffr