Direct Clinical Care Manager

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The Role

The Direct Care Clinical Care Manager is responsible for facilitating and delivering care to members to increase access to care and improve clinical outcomes. This position is self-directed and works collaboratively to close identified gaps in care, focusing on preventive screenings, management of chronic disease, and facilitating necessary follow-up care.

The Team

The Direct Care Clinical Care Manager is part of a dedicated team of professionals, including medical and behavioral health care managers, dieticians, pharmacists, clinicians, and medical directors, all collaborating to facilitate clinically appropriate quality care.

Key Responsibilities

• Conduct telehealth visits by video and phone with BCBSMA members, with varying volume each week and likely daily visits.
• Chronic disease management for Medicare-age members, specifically hypertension and diabetes via remote workflows.
• Creatively co-design an innovative virtual care program, including workflows and clinical protocols with Medical Director support for expanding clinical scope.
• Effective use of electronic medical record workflows and documentation.
• Engage members in appropriate plans of care, coordinate care and services as appropriate, communicate effectively, and provide members with education and resources as needed.
• Promote member compliance with treatment plan, encourage shared decision-making, and set appropriate goals to promote optimal member outcomes.
• Interpret and apply case management criteria, processes, policies, and regulatory standards to create, follow and appropriately document comprehensive care management plans.
• Review medication list and educate members with complex pharmacy needs, and counsel on side effects and mitigation strategies for specific treatment protocols.
• Successfully connect, engage, and maintain member engagement to support seamless care transitions and optimized health outcomes.
• Collaborate with treatment providers, PCPs, physicians, therapists, and facilities as needed to gather clinical information to support the plan of care.
• Monitor clinical quality concerns, make referrals appropriately, identify and escalation of quality of care issues.
• Understand BCBSMA products and benefits, as well as regulatory and NCQA requirements.

Key Qualifications

• Ability to identify and document member-driven, specific, measurable activities that address actionable behaviors and goals.
• Self-directed, independent, adaptive, flexible to change, and able to collaborate as a member of a team.
• Proficient with multiple IT systems.
• Demonstration of awareness, attitude, knowledge, and skills needed to work effectively with a culturally and demographically diverse population.

Education and Experience

Currently licensed as an NP in Massachusetts with 3-5 years recent experience in care delivery and willing to continue clinical practice. Ideally 10+ years' experience in ambulatory care, preferably as primary care provider for a population of patients. Proven abilities in patient engagement and relationship management. Minimum Education Requirements: High school degree or equivalent required unless otherwise noted above.

Location

Boston, Hingham

Time Type

Full time

Salary Range

$115,200.00 - $140,800.00 The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee’s pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay. We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Benefits

• Paid time off
• Medical/dental/vision insurance
• 401(k)
• Suite of well-being benefits to eligible employees

About Us

We’re committed to investing in your development and providing the necessary resources to enable your success. We are dedicated to creating a refreshing and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path. We take pride in our diverse, community-centric, wellness-focused culture and believe every member of our team deserves to enjoy a positive work-life balance.

We believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work" Page.

Blue Cross Blue Shield of Massachusetts is an Equal Employment Employer - veterans/disability. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or expression, or any other characteristics protected by law.

Blue Cross Blue Shield of Massachusetts will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with Blue Cross Blue Shield of Massachusetts's legal duty to furnish information.

Voted as the highest in member satisfaction among Massachusetts commercial health plans by JD Power, Blue Cross Blue Shield of Massachusetts is a community-focused, tax-paying, not-for-profit health plan headquartered in Boston. We have been a market leader for over 75 years, and are consistently ranked among the nation's best health plans. Our daily efforts are dedicated to effectively serving our 2.8 million members, and consistently offering security, stability, and peace of mind to both our members and associates.