Direct Clinical Care Manager

The Role  
The Direct Care Clinical Care Manager is responsible for facilitating and delivering care to members to increase access to care and improve clinical outcomes. This position is self-directed and works collaboratively to close identified gaps in care, focusing on preventive screenings, management of chronic disease, and facilitating necessary follow-up care.  

The Team 

The Direct Care Clinical Care Manager is part of a dedicated team of professionals, including medical and behavioral health care managers, dieticians, pharmacists, clinicians, and medical directors, all collaborating to facilitate clinically appropriate quality care.  

Key Responsibilities 

• Conduct telehealth visits by video and phone with BCBSMA members, with varying volume each week and likely daily visits. 

• Chronic disease management for Medicare-age members, specifically hypertension and diabetes via remote workflows. 

• Creatively co-design an innovative virtual care program, including workflows and clinical protocols with Medical Director support for expanding clinical scope.  

• Effective use of electronic medical record workflows and documentation. 

• Engage members in appropriate plans of care, coordinate care and services as appropriate, communicate effectively, and provide members with education and resources as needed. 

• Promote member compliance with treatment plan, encourage shared decision-making, and set appropriate goals to promote optimal member outcomes. 

• Interpret and apply case management criteria, processes, policies, and regulatory standards to create, follow and appropriately document comprehensive care management plans. 

• Review medication list and educate members with complex pharmacy needs, and counsel on side effects and mitigation strategies for specific treatment protocols. 

• Successfully connect, engage, and maintain member engagement to support seamless care transitions and optimized health outcomes. 

• Collaborate with treatment providers, PCPs, physicians, therapists, and facilities as needed to gather clinical information to support the plan of care. 

• Monitor clinical quality concerns, make referrals appropriately, identify and escalate quality of care issues. 

• Understand BCBSMA products and benefits, as well as regulatory and NCQA requirements 

Key Qualifications 

• Ability to identify and document member-driven, specific, measurable activities that address actionable behaviors and goals 

• Self-directed, independent, adaptive, flexible to change, and able to collaborate as a member of a team. 

• Proficient with multiple IT systems. 

• Demonstration of awareness, attitude, knowledge, and skills needed to work effectively with a culturally and demographically diverse population. 

Education and Experience 

• Currently licensed as an NP in Massachusetts with 3-5 years recent experience in care delivery and willing to continue clinical practice. 

• Ideally 10+ years' experience in ambulatory care, preferably as primary care provider for a population of patients.   

• Proven abilities in patient engagement and relationship management.