High Risk Nurse Case Manager

The High Risk Nurse Case Manager case manages the Blue Cross AQC (Alternative Quality Care) patient panels to ensure maximum quality measures are met. The Nurse Case Manager performs a variety of diverse and complex telephonic and face to face care management techniques, works closely with behavioral health staff to co-manage complex members, leads primary care team in creation of individualized care plans, follows patient through health care continuum, including acting as liaison for network staff, hospital staff, PCP and other healthcare team members and performs case management services taking into consideration the patient’s physical, cultural, social and psychological needs.

Minimum Skills, Experience and Educational Requirements: Bachelor’s Degree in Nursing, 3 years of experience in medical case management in acute care, ambulatory care or health insurance environment, strong analytical and clinical problem solving skills, experience with Microsoft Office application particularly MS Outlook, MS Word and Excel, strong oral and written communication skills, experience in using clinical data and developing interventions.

Required Certifications and Licenses: Current MA State License as Registered Nurse, professional certification as a Case Manager required within one year of employment.

Preferred Skills, Experience and Educational Requirements: Experience with Blue Cross Alternative Quality Care Contract, Clinical Care Management (CCM) Certification, Bilingual; demonstrates knowledge of providing culturally appropriate care, 3 years of related experience in ambulatory care environment, Master’s degree, NextGen experience, working knowledge of NCQA patient centered medical standards and GE Lean Principles.

Interested candidates please apply online at http://careers.hhsi.us/careers/ or for more information, please call 617-533-2300, email jtranford@hhsi.us or visit www.hhsi.us.