Blue Cross Blue Shield of Massachusetts

Manager

• Facilitate and deliver care to members to increase access to care and improve clinical outcomes
• Conduct telehealth visits by video and phone with BCBSMA members
• Manage chronic diseases for Medicare-age members, specifically hypertension and diabetes, through remote workflows
• Co-design an innovative virtual care program, including workflows and clinical protocols, with Medical Director support
• Use electronic medical record workflows and documentation effectively
• Engage members in plans of care, coordinate care and services, communicate effectively, and provide education and resources
• Promote treatment-plan compliance, shared decision-making, and goals for optimal outcomes
• Apply case management criteria, processes, policies, and regulatory standards to create and document comprehensive care management plans
• Review medication lists, educate members with complex pharmacy needs, and counsel on side effects and mitigation strategies
• Connect, engage, and maintain member engagement to support care transitions and health outcomes
• Collaborate with treatment providers, PCPs, physicians, therapists, and facilities to gather clinical information
• Monitor clinical quality concerns, make referrals, and identify and escalate quality-of-care issues
• Understand BCBSMA products and benefits and regulatory and NCQA requirements
• Work collaboratively with medical and behavioral health care managers, dieticians, pharmacists, clinicians, and medical directors

Direct Clinical Care Manager

Program Manager

• Lead end-to-end implementation of medium-to-high complexity payment integrity projects
• Plan and scope projects through implementation, launch, and post-launch analysis
• Develop and manage project plans covering scope, timelines, resources, and budgets
• Lead and coordinate cross-functional teams across IT, Claims, Analytics, and Provider Relations
• Serve as primary contact for high-visibility projects
• Provide status updates and reports to senior leadership and key stakeholders
• Identify, track, and mitigate project risks, issues, and dependencies
• Drive project execution, manage deliverables, and ensure milestones are met
• Hold team members and stakeholders accountable
• Define and track project metrics and KPIs
• Report completed-project business impact to leadership

Direct Clinical Care Manager

Program Manager II