Clinical Case Manager

2 months ago

Montpelier, United States BlueCross BlueShield of Vermont Full time
Job DescriptionJob Description

Blue Cross and Blue Shield of Vermont is looking for a Clinical Case Manager to join our Integrated Health team. Strong candidates include registered nurses or other licensed clinicians in the State of Vermont with case management experience in a health care setting. Our company culture is built on an unwavering focus on our members and giving them the best service possible. We offer a balanced, flexible workplace, an onsite gym, fitness and wellness programs, a competitive salary and full benefits package including medical and dental insurance, vision, 401k, paid time off and holidays, tuition reimbursement and student loan repayment, dependent caregiver benefits, and resources to support your ongoing personal and professional growth and development.

Remote Work: Blue Cross has transitioned to a hybrid workplace where employees within driving distance of our Berlin, VT office work Wednesdays in the office with flexibility to work remotely the rest of the week. Fully remote candidates (further than 50 miles from our Berlin, VT office), will be considered on a case-by-case basis.

Clinical Case Manager Responsibilities:

  • Perform the primary functions of case management–assessment, planning, facilitation, coordination, monitoring, evaluation, and advocacy–as appropriate in the health plan context to help members with high health complexity overcome biological, psychological, social and/or health system barriers to improvement and to achieve their desired clinical and functional outcomes.
  • Conduct comprehensive assessments and develop personalized care plans in accordance with professional case management and accreditation standards, using evidence-based tools and applying relationship-building, motivational interviewing, risk-prioritization, and other related skills.
  • Work collaboratively with members, families, and providers throughout the case management process, drawing upon knowledge of clinical, regulatory, and quality standards, health plan products and benefits, and community resources.
  • Support members at all stages of their health care journey and across multiple settings and specialty areas, connecting with multiple providers and community-based organizations; guide members in accessing services to support their health and wellness goals in accordance with their benefits, partnering effectively with the Plan’s customer service, providers relations, and/or utilization management teams.
  • Demonstrate a commitment to integrated, multi-disciplinary practice by proactively tapping into the expertise of the Plan’s clinical team of physicians, nurses, mental health clinicians, pharmacists, and colleagues in other departments who can help ensure the best possible experience and outcomes for the member.
  • Participate in department and organization-wide initiatives to enhance member health and wellness, improve the quality of care, and generate cost-savings for our customers.

Clinical Case Manager Qualifications:

  • Graduate of an approved program in professional nursing: RN, VT licensure and ability to apply for Compact License or active multi-state licensure required, BSN desired;
  • OR Licensed Clinical Social Worker (LICSW) in the State of Vermont or comparable degree and licensure in an allied mental health profession.
  • 5 years of varied clinical practice experience required, preferably in a health care setting. Experience in the following clinical areas strongly desired: inpatient and post-discharge care, management of chronic conditions, including medical and mental health conditions, and substance use disorders.
  • 1-3 years of case management or similar experience desired.
  • Active CCM certification preferred or initiated within 2 years of hire. Completion of CCM certification required within 3 years of hire

Clinical Case Manager Benefits:

  • Health insurance (including vision)
  • Dental coverage (free to employees)
  • Wellness Program
  • 401(k) with employer match + automatic employer contribution
  • Life Insurance
  • Disability Insurance
  • Combined time off (CTO) – 20 days per year + 9 paid holidays
  • Tuition Reimbursement
  • Student Loan Repayment
  • Dependent Caregiver Benefits

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