Case Manager- Knoxville, Nashville, or Memphis, TN

BlueCross BlueShield of Tennessee • Nashville, TN

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About The Position

BlueCross BlueShield of Tennessee is hiring a Care Transition Case Manager for the BlueCare Population Health Management Team. The role supports members with complex healthcare needs as they transition from hospital care to home and community settings. The Case Manager conducts face-to-face visits in area hospitals, collaborates with hospital care teams on discharge planning, and coordinates post-acute services to promote safe, effective transitions and improved health outcomes. The position also involves identifying care needs and barriers, connecting members with resources, and coordinating with members, providers, and internal and external care teams.

The position requires travel to Knoxville-area hospitals at least one day per week for in-person member visits and collaboration with facility staff. Candidates must live within 50 miles of Knoxville, Tennessee. Sponsorship is not available. Various immunizations and/or associated medical tests may be required. The role requires a digital literacy assessment and an 18-month commitment before applying for other internal positions. Employees who routinely operate a company, personal, or rental vehicle for company business must participate in the BCBST Driver Safety Program and meet its driving, insurance, and motor vehicle record requirements.

Requirements

• Active Registered Nurse (RN) license in Tennessee, or a license in the employee's state of residence if that state participates in the Nurse Licensure Compact.
• 3 years of clinical experience.
• 5 years of experience in the healthcare industry.
• Excellent oral and written communication skills.
• Basic Microsoft Office and email skills.
• Candidates must live within 50 miles of Knoxville, Tennessee.
• Ability to travel to Knoxville-area hospitals at least one day per week.
• For Select Community and Katie Beckett: 2 years of experience in IDD is required for Select Community.
• For employees who routinely drive for company business: valid driver's license, compliance with minimum auto insurance liability requirements when using a personal or rental vehicle, and an acceptable motor vehicle record.
• Ability to complete a digital literacy assessment.

Nice To Haves

• Experience in home health, community-based nursing, public health or health department settings, and/or community hospitals.
• Strong clinical judgment, critical thinking, time management, and prioritization skills.
• Self-motivation, collaboration, and passion for improving member outcomes.

Responsibilities

• Support utilization management functions for more complex and non-routine cases as needed.
• Serve as a liaison between members, providers, and internal and external customers in coordinating healthcare delivery and benefits programs.
• Oversee highly complex cases identified through various mechanisms to ensure interventions are effectively implemented and benefits are efficiently utilized.
• Perform case management activities, including assessment, planning, implementation, coordination, monitoring, outcomes, and evaluation.
• Conduct in-person member visits at area hospitals and collaborate with facility staff on discharge planning.
• Coordinate services that support transitions from acute care to home and community-based care.
• Communicate effectively through digital channels and offer technical support in digital positions.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed