RN Care Manager

Capital Blue Cross

. Coordinate services for members who meet established criteria .

Posted 10/2/2026full-timeRemote • Pennsylvania • United StatesMid-LevelSenior💰 $29 - $54 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in case management, including the development and implementation of individualized care plans, while effectively coordinating resources and collaborating with interdisciplinary teams. Proficient in assessing member needs and applying evidence-based guidelines to promote quality care and cost-effective outcomes.

Highest-signal resume keywords

Registered Nurse LicensureCertified Case Management CertificationKnowledge of NCQA StandardsExperience in Health CoachingStrong Clinical Process Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Case ManagementCare CoordinationAssessment and EvaluationDischarge PlanningCritical ThinkingProblem-SolvingMotivational InterviewingEvidence-Based GuidelinesChronic Condition ManagementClinical Principles

Soft Skills

Interpersonal CommunicationAutonomous WorkTeam CollaborationCounseling SkillsConfidentiality Maintenance

Tools & Technologies

Microsoft Office Products

Certifications & Qualifications

Registered Nurse LicensureCertified Case Management Certification

Industry Keywords

Population Health ManagementDisease ManagementCMSA Standards of PracticeAct 68CMSERISAManaged Care PrinciplesHealth Plan ExperienceBehavioral HealthHome Health

About the role

Key responsibilities & impact

Coordinate services for members who meet established criteria
Educate members and promote self-management, quality care, and cost-effective outcomes
Assess member needs and review service and resource options
Develop and implement individualized plans of care
Coordinate resources and monitor member progress
Evaluate member status and discharge members when criteria are met
Document the individualized member care management process and outcomes
Address medical, psychosocial, clinical, behavioral health, mental health, and substance use disorder needs
Provide counseling and referrals to community, local, and state programs
Collaborate with caregivers, providers, community agencies, behavioral health teams, and other resources
Manage and oversee a caseload of moderate- to high-risk members with complex needs
Serve as a liaison among participants, families, physicians, and treatment-team members
Analyze and evaluate referrals for potential program enrollment
Conduct assessments to determine acuity, functional status, psychosocial status, and barriers
Obtain required consent forms
Apply discharge criteria and discharge members from care management programs
Identify and report quality-of-care issues
Maintain member confidentiality
Attend company and departmental meetings and training sessions

Requirements

What you’ll need

Registered Nurse with active licensure in home state
Additional state licensure as needed/required to meet customer needs
Certified Case Management certification within 2 years of employment
At least three (3) years’ recent/related experience
Knowledge of NCQA standards for Population Health Management
Knowledge of DMAA standards for disease management
Knowledge of CMSA Standards of Practice for Case Management
Knowledge of Act 68, CMS, and ERISA
Knowledge of evidence-based guidelines for chronic conditions/care management
Knowledge of clinical and managed care principles and operations
Knowledge of current and emerging medical treatment modalities and best practice guidelines
Knowledge of adult learning principles, motivational interviewing, and intrinsic coaching techniques
Proficiency in Microsoft Office Products
Strong clinical process, critical thinking, and problem-solving skills
Ability to work autonomously and as part of an interdisciplinary team
Compact RN license preferred
Care management, home health, medical/surgical behavioral health, and/or critical care experience preferred
Health plan experience preferred
Experience in health coaching and motivational interviewing techniques preferred

Benefits

Comp & perks

Medical coverage
Dental coverage
Vision coverage
Retirement Plan
Paid Time Off
Holidays
Volunteer time off
Incentive Plan
Tuition Reimbursement
Flexible work environment
Training and continuing education
Community volunteering opportunities