Concierge Care Manager

BlueCross BlueShield of South Carolina•Columbia, SC

About The Position

Provides care management services to more than 2 million members in South Carolina and nationally. Administers complex, high-touch concierge case management for members identified into specialized programs such as high-risk maternity, NICU, ESRD, Cancer, Palliative Care or Behavioral Health. Identifies risks and provides outreach services to facilitate the coordination of healthcare services and gap closure. Provides individualized care plans to ensure cost-effectiveness, overall care satisfaction, and improved quality of life.

Requirements

Associate’s degree in Nursing; OR Graduate of Accredited School of Nursing; OR Master's degree in Social Work, Psychology, or Counseling (Div. 75 and 6B) only.
5 years' case management experience as a RN or 2 years’ case manager experience as a RN in a health insurance environment.
Working knowledge of word processing software.
Knowledge of quality improvement processes and demonstrated ability with these activities.
Knowledge of contract language and application.
Ability to work independently, prioritize effectively, and make sound decisions.
Demonstrated customer service, organizational, and presentation skills.
Demonstrated proficiency in spelling, punctuation, and grammar skills.
Demonstrated oral and written communication skills.
Ability to persuade, negotiate, or influence others.
Analytical or creative thinking skills.
Ability to handle confidential or sensitive information with discretion.
Microsoft Office
Active, unrestricted RN licensure from the United States and in the state of hire; OR active, compact, multistate, unrestricted RN license as defined by the Nurse Licensure Compact (NLC); OR active licensure as a social worker, psychologist, or counselor in state of hire (Div. 75 only).
Nationally recognized Case Management certification to be obtained within 2 years of hire as a Case Manager.

Nice To Haves

Bachelor's degree in health-related field (Nursing, Healthcare Administration, Pharmacy, Sciences, Applied Health)
5 years’ experience in case management in a sub-specialty area (i.e. ICU, Palliative Care, Hospice, or Home Health)
Strong communication and customer services skills.
Excellent analytical skills to problem solve and remedy issues immediately.
Ability to work in an autonomous environment or leadership capacity.
Working knowledge of Microsoft Word, PowerPoint, Excel, or other spreadsheet/database software; TMCS, MDDS, and BlueVue.
Case manager certification, clinical certification in specialty area.
Basic Life Support (BLS) or Advanced Cardiac Life Support (ACLS) certification.

Responsibilities

Directs day-to-day, high-touch member management to include implementation of program goals, coordination of treatment plans and benefit coordination for high-risk patient populations and/or those with complex conditions.
Coordinates clinical services with external sources to include: providers, vendors, facilities, social workers/case managers and/or community services.
Participates in team training and continuing medical education.
Prepares for external audits and quality assurance efforts.