Case Manager, Maternity (RN or LMSW)

Join to apply for the Case Manager, Maternity (RN or LMSW) role at Excellus BCBS

Case Manager, Maternity (RN or LMSW) is accountable for delivering comprehensive case management services to maternity members, ensuring coordinated care across providers and community resources. Activities are conducted in accordance with departmental, corporate, state, and federal regulations, as well as national accreditation standards.

Essential Accountabilities

Handles physical health member clinical management programs.

Maintains up-to-date knowledge of CMSA, NCQA, and other relevant standards.

Performs clinical duties in compliance with state, federal, and accreditation requirements.

Manages confidentiality and follows corporate information‑management procedures.

Implements the Case Management Process including case identification, opening, assessment, education, care planning, intervention, outcome measurement, and case closure.

Screen members for eligibility and initiate timely case management.

Utilize motivational interviewing to achieve member health goals.

Collaborates with physicians and other providers to develop and modify care plans.

Provides education on illness and health goals.

Act as a liaison between members and community resources.

Participates in interdisciplinary coordination (Utilization Management, Quality, Behavioral Health, Pharmacy, Dietitian, Respiratory Therapist).

Maintains continuing education requirements.

Promotes preventive health and digital health programs.

Collaborates with peers across clinical specialties for continuity of care.

Contributes to value‑based payment initiatives.

Demonstrates integrity and adherence to corporate values.

Respects privacy in line with corporate policies.

Assists in new staff orientation.

Maintains reliable attendance.

Performs additional duties as assigned.

Additional Accountability Levels

Level II: Manages complex assignments, mentors junior staff, meets productivity metrics, works independently, and manages larger caseloads.

Level III: Drives process improvement, serves as subject‑matter expert, mentors staff, ensures regulatory compliance, and backs up leadership.

Minimum Qualifications

Associate’s degree required, Bachelor’s preferred.

Active NYS RN, Registered Dietician, or Physical Therapist license.

Minimum 3 years of clinical experience; case‑management experience preferred.

Proficiency in Microsoft Office Suite.

Knowledge of Medicare and Medicaid managed‑care plans.

Strong written and verbal communication skills.

Ability to multitask and work independently.

Deliver efficient, seamless member care.

FEP case‑management certification required within 3 years for FEP line of business.

Level II: Minimum 2 years in case‑management; certification preferred.

Level III: Minimum 5 years; certification required.

Physical Requirements

Ability to travel and work long hours on a computer.

Flexibility to accommodate member discussions.

Compensation
Level I / E2: $60,410 – $96,081

Level II / E3: $60,410 – $106,929

Level III / E4: $65,346 – $117,622

Company Culture
Employees are united by our Lifetime Way Values & Behaviors: compassion, pride, excellence, innovation, and fun. We are committed to inclusivity, continuous learning, and competitive compensation.

One Mission. One Vision. One I.D.E.A. One you. Together we can create a better I.D.E.A. for our communities.

We aspire for our employees’ interests and values to reflect the communities we serve and strongly encourage all qualified individuals to apply.

Equal Opportunity Employer

Remote work may be available on a case‑by‑case basis.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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