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Blue Cross Blue Shield of Massachusetts RN Case Manager l Registered Nurse l TrueCare 360 Program in Quincy, Massachusetts

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The telephonic RN Case Manager position is an essential member of the multidisciplinary TrueCare 360 program at BCBSMA. This care management position which supports a Primary Nurse Model, requires enhanced communication and coaching skills as well as the ability to align with members and their families. This alignment focuses on solving member-centric problems and developing patient goals, through appropriate targeted interventions. The telephonic RN Case Manager also focuses on arranging or coordinating services that the member needs to get well or stay well by removing barriers that prevent the member from engaging in appropriate plans of care. These principles and core technology of case management are applied to members across various product lines, benefits, demographics, conditions, and programs.

Major Responsibilities:

  • Assess and evaluate member needs and benefits by using various data tools and resources

  • Engage members and their families in the administration of their health plan benefits, promote medication compliance, align with healthcare professionals, as well as assist in shared decision-making

  • Collaborate within a team of professionals (supervisors, managers, account representatives, member service associates, and physicians) to provide care coordination appropriate for members

  • Interpret and apply case management criteria, processes, policies, and regulatory standards

  • Interact with treatment providers, PCPs, and physicians as needed to support the plan of care

  • Monitor for clinical quality concerns and refers appropriately

  • Provides telephone triage and crisis intervention when situation warrants, collaborating with utilization management peers when appropriate

    Qualifications and Skills:

  • Ability to adapt and be flexible to change as priorities within this environment change constantly

  • Willingness to learn new skills from both a business and clinical perspective

  • Strong teamwork and communication skills as well as ability to be self-directive

  • Ability to analyze information to construct effective solutions

  • Execution and results (ability to set goals, follow processes, meet deadlines, and deliver expected outcomes with appropriate sense of urgency)

  • Cultural competence (demonstration of awareness, attitude, knowledge, and skills to work effectively with a culturally and demographically diverse population)

  • Clinical assessment (ability to interpret, evaluate, and clearly document complex medical information using a directive and focused approach in order to identify relevant and actionable conditions, circumstances, and behaviors)

  • Care planning (ability to identify and clearly document member-driven, specific, measurable activities that address actionable conditions, circumstances, and behaviors in order to improve health outcomes and cost-effectiveness of services)

  • Member collaboration and engagement (ability to secure and maintain the motivation, participation, and collaboration of all relevant parties in a purposeful plan to improve health outcomes and cost-effectiveness of service delivery)

    Education/Relevant Experience:

  • Minimum 3-5 years working as a Registered Nurse AND have worked in one or more in the following settings within the last 12 months: medical-surgical unit, critical care unit, telemetry unit, sub-acute unit, SNF, LTAC, VNA, home care, and/or other extended care facilities

  • Case Management and/or Triage experience, strongly desired

  • Active Massachusetts RN License is required. Licensure in additional states, a plus. Please Note: Any restrictions against a license must be disclosed and reviewed

  • Demonstrated knowledge working with Microsoft Word, Outlook, PowerPoint, and Excel

  • Managed care plans and health insurance experience is a plus

  • Bachelor’s degree in nursing, is preferred

  • Certified Case Manager (CCM), is preferred

    Schedule of Hours:

  • Flexibility is required

  • Standard working hours are Monday through Friday anywhere from 8am-6pm (Typical shift is 8:30-4:30)

  • You may be required to work one evening a week, until 8pm to support our west coast membership

  • You may be required to work one Saturday a month to accommodate our member’s needs

  • Flexible working hour options.

Minimum Education Requirements:

High school degree or equivalent required

LocationQuincyTime TypeFull time

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. We provide a flexible hybrid work model in which roles are designated as resident (on site 4-5 days/week), mobile (on site 1-3 days/week), or eworker (on site 0-3 days/month).

Blue Cross Blue Shield of Massachusetts, has a COVID-19 vaccination requirement for building entry. Your offer of employment is dependent upon either being fully vaccinated for COVID-19, or receiving an eworker exemption and/or accommodation based on a disability or sincerely held religious belief, practice, or observance by submitting a request to Human Resources.

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.

Our Commitment to You

We are 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.

Blue Cross Blue Shield of Massachusetts is an Equal Employment / Affirmative Action Employer. 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.

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