Manager of Care Management Operations & Strategy

Pay Range:

$116,900.00 - $187,100.00

Please email HR_Talent_AcquisitionTeam@bcbsri.org if you are a candidate seeking a reasonable accommodation for the application and/or interview process.

At BCBSRI, our greatest resource is our people.

We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do—not just for our members, but for our employees as well.

We recognize that to do your best work, you have to be your best self.
It’s why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees.

Our culture is one of belonging.
We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you’re at in the organization, you’re an integral part of our team and your input, thoughts, and ideas are valued.

Join others who value a workplace for all.
We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders.

We’re dedicated to serving Rhode Islanders.
Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state—building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer.

Must reside within a commutable distance (RI,MA,CT).

Why this job matters:

Responsible for the day-to-day leadership, operations, performance, and oversight of clinical care management team and programs. This role leads a multidisciplinary team of nurses, health advocates, and support staff to improve member health outcomes, enhance the member experience, reduce avoidable healthcare costs, and achieve organizational quality and performance goals.

What you will do:

• Provide operational oversight to ensure care management activities align with organizational goals, population health strategies, and evidence-based best practices.
• Use data and performance metrics to evaluate care management workload and activity, assess effectiveness, identify opportunities, and drive continuous improvement

• Support ongoing development, implementation, and integration of care and disease management programs while maintaining compliance with regulatory and accreditation requirements (e.g., Department of Health, NCQA, CMS, URAC).
• Provide timely direction and feedback to downline to support performance management and employee development.
• Partner with Quality, Population Health, Behavioral Health, Pharmacy, Utilization Management, and customer service to support integrated, coordinated care delivery.
• Lead, mentor, and develop high performing care management teams; foster a culture of accountability, innovation, and continuous improvement.
• Perform other duties as assigned.

What you need to succeed:

• Bachelor’s degree in Nursing or related field, or an equivalent combination of education and experience with active and unrestricted RN license issued by a state participating in the Nurse Licensure Compact (NLC)
• Five to seven years experience in utilization review, case management, and/or disease management and up to five years clinical nursing or other related applicable experience
• Three to five years management experience or experience leading a team
• Knowledge of managed benefits strategies, utilization review techniques, health care financing and delivery, program development, care management, quality management, and health care administration
• Knowledge of evidence based clinical practice
• Ability to coach and motivate to maximize performance
• Ability to effectively communicate goals and business objectives to employees
• Strong and effective decision-making skills
• Strong organization and time management skills
• Proficiency with Microsoft Suite of products (i.e., Word, Excel, PPT, etc.)
• Ability to effectively interact with all levels of the organization
• Ability to effectively delegate work and manage project tasks
• Excellent verbal and written communication skills, with ability to convey complex or technical information in an effective manner

The extras:

• Possession and maintenance of Case Management Certification (CCM) within three (3) years tenure in the position.

Location:
BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role:

• In-office: onsite 5 days per week
• Hybrid: onsite 2-4 days per week
• Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia
  

Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today’s healthcare industry. BCBSRI is an equal opportunity employer.

The law requires an employer to post notices describing the Federal laws. Please visit  www.eeoc.gov/know-your-rights-workplace-discrimination-illegal to view the "Know Your Rights" poster.

Why work here?

At BCBSRI, our greatest resource is our people.

We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do—not just for our members, but for our employees as well.

We recognize that to do your best work, you have to be your best self.
It’s why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees.

Our culture is one of belonging.
We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you’re at in the organization, you’re an integral part of our team and your input, thoughts, and ideas are valued.

Join others who value a workplace for all.
We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders.

We’re dedicated to serving Rhode Islanders.
Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state—building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer.

Location:
BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules, based on role:

• In-office: onsite 5 days per week
• Hybrid: onsite 2-4 days per week
• Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia

Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today’s healthcare industry. BCBSRI is an equal opportunity employer.

The law requires an employer to post notices describing the Federal laws. Please visit  www.eeoc.gov/know-your-rights-workplace-discrimination-illegal to view the "Know Your Rights" poster.