Premera Blue Cross

Manager, Case Management

Premera Blue Cross

full-time

Posted on:

Location Type: Hybrid

Location: Alaska • Arizona • United States

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Salary

💰 $89,300 - $151,800 per year

About the role

  • Participate in development of Clinical Programs’ strategy and planning in accordance with company's mission and strategic goals, federal and state law and regulations, and accreditation standards.
  • Assist in the selection, training, evaluation, and development of professional paraprofessional, and administrative team members.
  • Lead Care Management teams in effective performance of job functions, which may include preauthorization, outpatient and inpatient management, case management, retrospective claim review, and delegated management oversight.
  • Participate in the development and monitoring of budgets in accordance with department and organizational objectives.
  • Assist with the adjustment and direction of work processes to support cost and utilization variations.
  • Participate in the development, implementation, and monitoring of the department's performance standards, utilizing quality improvement methodologies to refine procedures.
  • Participate in the establishment and implementation of Care Management policies as required.
  • Foster collaborative work environment that encourages team building, facilitates cohesive synergetic performance of Care Management functions, while valuing the individual diversity and uniqueness of all employees.
  • Build and maintain cooperative business relationships.
  • Participate in Total Quality Management activities and processes to assure operational compliance with regulatory requirements, including NCQA, NEMIS, HCFA, and OIC.
  • Ensure team members that can articulate the expectations of performances are invested in productivity and customer service, and can describe a positive feeling about the work environment.
  • Effectively manages deficits with improvement plans and consistent follow-up.

Requirements

  • Candidates with a RN License are highly preferred.
  • Current state credential (e.g. licensure) that allows the professional to conduct an assessment independently as permitted within the discipline's scope of practice (Required) :
  • For nurses, required registration (e.g. RN, ARNP).
  • For behavioral health, required licensure (e.g. LMFT, LICSW, LPC, LMHC)
  • For psychologist, required board certification
  • For dietitians, required certification as a nutritionist or dietician
  • Or licensure in related healthcare discipline
  • Certified in CCM (Certified Case Management) or obtain certification within 24 months of date of hire. (Required)
  • Five (5) years case management or health care experience. (Required)
  • Three (3) years management experience. (Required)
  • Advanced degree such as Master's Degree in a Health-Related field preferred.
  • Experience with NCQA, URAC, or accreditation review processes
  • Experience in continuous process improvement and creative problem solving (e.g. LEAN, Synectic)
  • Advanced training in Motivational Interviewing
  • Experience training clinical and non-clinical staff
  • Experience managing case management teams and integrated case management model
Benefits
  • Medical, vision, and dental coverage with low employee premiums.
  • Voluntary benefit offerings, including pet insurance for paw parents.
  • Life and disability insurance.
  • Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service.
  • Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few.
  • Generous paid time off to reenergize.
  • Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees.
  • Employee recognition program to celebrate anniversaries, team accomplishments, and more.
  • For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.
  • Commuter perks make your trip to work less impactful on the environment and your wallet.
  • Free convenient on-site parking.
  • Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.
  • Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.
  • Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.
  • Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus.
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
case managementcontinuous process improvementbudget developmentperformance standards monitoringpreauthorization managementoutpatient managementinpatient managementretrospective claim reviewdelegated management oversightMotivational Interviewing
Soft Skills
team buildingcollaborative work environmentleadershipcommunicationproblem solvingcohesive performanceemployee diversity appreciationcustomer serviceperformance managementtraining and development
Certifications
RN LicenseCCM (Certified Case Management)LMFTLICSWLPCLMHCboard certification for psychologistsnutritionist certificationdietician certification