Disease Case Manager - Renal Disease Management

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.

Disease Case Manager, Renal Disease Management

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:

Implement care management to a focused population that includes management of disease specific and co-morbid conditions for all eligible members, across the continuum of care.

Collaborate with disease management vendor to co-manage services and care.

Facilitate communication between members/families, providers, medical staff and disease management vendor with information relating to medical management, benefits and the case management process.

Collaborate with members/families, providers, medical staff and/or others in order to develop, implement/authorize and document treatment plans that include treatment goals, interventions and expected clinical outcomes.

Educate members/families regarding benefits, disease process, appeals process, and community/other resources with a goal of empowering self-advocacy.

Manage member??s benefits to maximize health care dollars.

Educate members regarding their disease process and self-management strategies.

Articulate to providers and members goals, intent and interventions for disease management program.

Qualifications (Knowledge, skills and abilities):

Excellent organization, problem-solving and communication skills

Ability to manage multiple projects in conjunction with patient caseload

Computer skills, Word, Excel, Access

Foster teamwork as an attitude and a skill

Proven customer service skills

Ability to manage complicated members with a chronic disease and their associated co-morbidities

Experience with patient population preferred


Registered Nurse with an active professional Massachusetts license

3-5 years of clinical experience in medical/surgical care

BS in Nursing preferred

Case management experience and CCM preferred

Home care and/or Dialysis Center experience a plus/prior experience in disease management preferred