Medical Case Manager

BlueCross BlueShield of Tennessee•Nashville, TN

20h•Remote

About The Position

BlueCross BlueShield of Tennessee (BCBST) is seeking a skilled and compassionate Medical Case Manager to join the FEP Population Health team. This role supports members with acute care needs and chronic health conditions, ensuring they receive timely, coordinated, and high‑quality care. Team members play a critical role in guiding individuals through complex health situations while delivering a compassionate and seamless member experience. The ideal candidate brings a strong background in health insurance and telephonic member engagement, with FEP experience considered a valuable asset. They are energized by meaningful member interactions and excel at empathetic listening, clear communication, and proactive problem solving. A Certified Case Manager (CCM) credential is highly preferred, along with adaptability, initiative, and experience managing complex patient needs. Successful candidates are confident navigating challenging situations, building trust over the phone, and making a genuine impact through exceptional service. This is an opportunity to make a meaningful impact every day by helping individuals lead healthier, more fulfilling lives through comprehensive care management. Note: RN Case Managers must be available for occasional late‑shift rotation once a year (9 am–6 pm Central / 10 am–7 pm Eastern). Although we are based in Chattanooga, TN, this is a fully remote role. Sponsorship is not available for this position. At BCBST, we foster a culture where innovation is encouraged, including the responsible use of AI-enabled tools to support everyday work. As roles become more advanced, employees are expected to leverage AI, guided by established workflows, templates, and policies, to improve how we serve our members.

Requirements

License Registered Nurse (RN) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law.
3 years - Clinical experience required
5 years - Experience in the health care industry
For Select Community & Katie Beckett: 2 years experience in IDD for Select Community is required
Excellent oral and written communication skills
PC Skills required (Basic Microsoft Office and E-Mail)
Employees who are required to operate either a BCBST-owned vehicle or a personal or rental vehicle for company business on a routine basis will be automatically enrolled into the BCBST Driver Safety Program.
The employee will also be required to adhere to the guidelines set forth through the program.
This includes, maintaining a valid driver’s license, auto insurance compliance with minimum liability requirements; as defined in the “Use of Non BCBST-Owned Vehicle” Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR).
The definition for "routine basis" is defined as daily, weekly or at regularly schedule times.
Proficient in the Microsoft Office suite, including Microsoft Teams
Organized
Capable of managing multiple assignments or projects simultaneously.
Strong interpersonal abilities

Nice To Haves

FEP experience considered a valuable asset.
Certified Case Manager (CCM) credential is highly preferred.
Adaptability
Initiative
Experience managing complex patient needs.

Responsibilities

Supporting utilization management functions for more complex and non-routine cases as needed.
Serving as a liaison between members, providers and internal/external customers in coordination of health care delivery and benefits programs.
Overseeing highly complex cases identified through various mechanisms to ensure effective implementation of interventions, and to ensure efficient utilization of benefits
Performing the essential activities of case management: assessment: planning, implementation, coordinating, monitoring, outcomes and evaluation.
Digital positions must have the ability to effectively communicate via digital channels and offer technical support.
This Position requires an 18 month commitment before posting for other internal positions.
Various immunizations and/or associated medical tests may be required for this position.
This job requires digital literacy assessment.