Premera Blue Cross
Manager, Case Management
Aug 14, 2024
Full-time
Full Job Description

Workforce Classification:

Telecommuter


Join Our Team: Do Meaningful Work and Improve People’s Lives

Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

To better serve our customers, we are fostering a culture that emphasizes employee growth, collaborative innovation, and inspired leadership. We are dedicated to creating an environment where employees can excel and where top talent is attracted, retained, and thrives. As a testament to these efforts, Premera has been recognized on the 2025 America's Dream Employers list. In 2024, Newsweek honored Premera as one of America's Greatest Workplaces, America's Greatest Workplaces for Diversity, and America's Greatest Workplaces for Mental Wellbeing. Additionally in 2024, Forbes ranked Premera among America’s Best Midsize Employers for the fourth time.

Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.premera.com/.

This is a work from home opportunity!

The Manager, Case Management Team is a Supervisor for Case Managers. This position is responsible for the execution and implementation of Clinical Programs’ strategy and goals and the oversight of Clinical Programs’ operations. The incumbent oversees the effective integration and continuous improvement of processes and systems to meet Premera’s current and future business goals. Responsibilities also include managing and developing a team of clinical and support staff promoting their professional growth and operational effectiveness.

What you'll do:

  • Participate in development of Clinical Programs’ strategy and planning in accordance with company's mission and strategic goals, federal and state law and regulations, and accreditation standards.
  • Assist in the selection, training, evaluation, and development of professional paraprofessional, and administrative team members.
  • Lead Care Management teams in effective performance of job functions, which may include preauthorization, outpatient and inpatient management, case management, retrospective claim review, and delegated management oversight.
  • Participate in the development and monitoring of budgets in accordance with department and organizational objectives.
  • Assist with the adjustment and direction of work processes to support cost and utilization variations.
  • Participate in the development, implementation, and monitoring of the department's performance standards, utilizing quality improvement methodologies to refine procedures.
  • Participate in the establishment and implementation of Care Management policies as required.
  • Foster collaborative work environment that encourages team building, facilitates cohesive synergetic performance of Care Management functions, while valuing the individual diversity and uniqueness of all employees.
  • Build and maintain cooperative business relationships.
  • Participate in Total Quality Management activities and processes to assure operational compliance with regulatory requirements, including NCQA, NEMIS, HCFA, and OIC.
  • Ensure team members that can articulate the expectations of performances are invested in productivity and customer service, and can describe a positive feeling about the work environment.
  • Effectively manages deficits with improvement plans and consistent follow-up.
  • As part of this role, you may be assigned internal controls derived from Premera’s internal controls framework. You will be accountable for understanding the controls assigned to you, their impacts on Premera, and to ensure that they are operating effectively.

What You’ll Bring:

  • Candidates with a RN License are highly preferred.
  • For nursing, Associate’s Degree in Nursing plus a Bachelor’s degree; or Bachelor's degree in Nursing; for behavioral health, Master’s degree in Social Work, Marriage and Family Therapy, Mental Health Counseling, or related degree. (Required)
  • Current state credential (e.g. licensure) that allows the professional to conduct an assessment independently as permitted within the discipline's scope of practice:
    • For nurses, required registration (e.g. RN, ARNP).
    • For behavioral health, required licensure (e.g. LMFT, LICSW, LPC, LMHC)
    • For psychologist, required board certification
    • For dietitians, required certification as a nutritionist or dietician.
    • Or licensure in related healthcare discipline. (Required)
  • Certified in CCM (Certified Case Management) or obtain certification within 24 months of date of hire. (Required)
  • Five (5) years case management or health care experience. (Required)
  • Three (3) years management experience. (Required)
  • Advanced degree such as Master's Degree in a Health-Related field preferred.
  • Experience with NCQA, URAC, or accreditation review processes
  • Experience in continuous process improvement and creative problem solving (e.g. LEAN, Synectic)
  • Advanced training in Motivational Interviewing
  • Experience training clinical and non-clinical staff
  • Experience managing case management teams and integrated case management model

Premera total rewards

Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Our total rewards are more than a collection of perks, they're a reflection of our commitment to your health and well-being. We offer a broad array of rewards including physical, financial, emotional, and community benefits, including:

  • Medical, vision, and dental coverage with low employee premiums.

  • Voluntary benefit offerings, including pet insurance for paw parents.

  • Life and disability insurance.

  • Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service.

  • Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few.

  • Generous paid time off to reenergize.

  • Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees.

  • Employee recognition program to celebrate anniversaries, team accomplishments, and more.

For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.

  • Commuter perks make your trip to work less impactful on the environment and your wallet.

  • Free convenient on-site parking.

  • Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.

  • Engaging on-site events and activities include food trucks, health and wellness, DEI and disaster preparedness fairs, coffee connects, and more.

  • Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.

  • Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus.

Equal employment opportunity/affirmative action:

Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.

If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at careers@premera.com or via phone at 425-918-4785.

Premera is hiring in the following states, with some limitations based on role or city: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin.

The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience.

The salary range for this role is posted below; we generally target up to and around the midpoint of the range.

National Salary Range:

$87,000.00 - $147,900.00

National Plus Salary Range:

$99,100.00 - $168,500.00

*National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska.

We’re happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all. We’re committed to creating a diverse and inclusive environment where all employees are celebrated for their unique skills and contributions.

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Information Technology
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Manager, Case Management
Premera Blue Cross
Aug 14, 2024
Full-time
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