Clinical Case Manager

Job Description

Job 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 :

Clinical Case Manager Benefits :