Case Manager, Rn

Premera Blue Cross Premera Blue Cross · Insurance · Telecommuter

This role focuses on providing case management services to healthcare members, helping them transition towards healthier lifestyles through holistic assessments, personalized care plans, and coordination with healthcare providers. It involves engaging members with medical, mental health, and substance use disorders, monitoring their progress, and facilitating communication within the healthcare team. The role requires active nursing or behavioral health licensure and experience in direct patient care, with preferred experience in case management and specific certifications.

What you'd actually do

  1. Engage target members (those who are facing medical, mental health and/or substance utilization disorders) and build a relationship that will support open and constructive dialog on sensitive topics.
  2. Conduct initial holistic health assessments that help build an understanding of a member’s specific situation and needs and identify any social determinants of health (SDOH) and cultural influences that may impact potential lifestyle changes.
  3. Create a space where a case manager and member can collaborate, along with relevant caregivers and providers, to develop a member-centric case management plan that sets goals, addresses potential barriers, and leads to improved health outcomes.
  4. Monitor, evaluate, and update the effectiveness of the member's case management plan to ensure progress toward goals is being made and that current goals remain pertinent.
  5. Facilitate communication and coordination among the health care team to maximize delivery of appropriate care.

Skills

Required

  • Active WA State or Compact License in Nursing (RN, ARNP), Behavioral Health (LMFT, LICSW, LMHC), or Psychology (Board certification)
  • 3 years' experience with direct patient/clinical care post-licensure
  • High-speed cable, DSL, or Fiberoptic Internet (no less than 75 Mbps)

Nice to have

  • 1+ years prior experience as a Case Manager
  • Certified Case Manager (CCM) certification
  • Chemical Dependency Professional (CDP)
  • Chronic Care Professional certification (CCP)
  • LEAN training
  • Advanced Motivational Interviewing skills