Oncology- Insurance Nurse Case Manager

Today's healthcare industry -- dynamic and changing at a fast pace. Recruiting talented people can mean the difference between success or failure. At Blue Cross and Blue Shield of Massachusetts, our record of achievement represents a history of hiring the best people we can find, and then challenging them to excel. It's the kind of environment that enables us to give our best to the consumers we serve, and at the same time, work to the potential of those who work for us. Blue Cross Blue Shield of Massachusetts is an Equal Opportunity 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, or any other characteristics protected by law.Major Responsibilities Identifies member needs and coordinates case management plan. Collaborates with members/families, providers, medical staff and/or others in order to develop, implement, monitor, evaluate and document case management plans. Documents treatment and case management goals, interventions, expected and actual clinical and financial outcomes. Identifies and intervenes on quality issues. Facilitates communication between members/families, providers, medical staff and/or others with information related to benefits and the case management process. Educates members/families regarding case management, benefits, needs related to clinical condition, appeals process, and community/other resources with a goal of empowering self-advocacy. Collaborates with physician reviewers and other departments within BCBSMA. Applies MCAP criteria for specified levels of care to assist in determination of medical appropriateness. Manages member benefits to maximize health care dollars. Other responsibilities as assigned by management. Excellent organization, problem-solving and communication skills. Ability to manage multiple projects in conjunction with patient caseload. Computer skills. Foster teamwork as an attitude and a skill. Demonstrated customer service skills. Registered nurse with an active professional Massachusetts license. 3-5 years of clinical experience in an acute care setting. Home care experience a plus. Case Management experience. Utilization management experience. BS in Nursing or health-related field preferred. CCM preferred. Position Information Location:  Quincy, MA 02171 Job Category:  Medical/Health Reference Code:  bcbs-00001450 Our commitment to building a diverse workplace is without question. We are an Equal Opportunity Employer.