RN Concierge Care Manager – Case Management

BlueCross BlueShield of South Carolina

21d•Remote

About The Position

We are currently hiring for an RN Concierge Care Manager – Case Management to join BlueCross BlueShield of South Carolina. In this role as an RN Concierge Care Manager – Case Management, you will provide care management services to more than 2 million members in South Carolina and nationally, administer 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, identify risks and provides outreach services to facilitate the coordination of healthcare services and gap closure, and provide individualized care plans to ensure cost-effectiveness, overall care satisfaction, and improved quality of life. The position will be fully remote on a desktop computer to provide highly interactive case management to assigned members. Members will include those with chronic or high-risk conditions and those who are admitted to inpatient care. You will educate and guide members through prior authorizations and understanding the need to adhere to medications and the plan of care. Most interactions will be by phone and through our messaging system, perfect for those who love case management and improving the lives and medical outcomes of members while working in your own home office. To work from home, you must have high-speed (non-satellite) internet and a private, secure home office. Attach a copy of your current RN license report to your application, or Include your RN license number on your resume Candidates who live within 50 miles of the Columbia office (4101 Percival Rd Ste 120, Columbia, SC 29229) and reside in South Carolina will be required to come on-site for one day of orientation to receive their equipment. After orientation, the position will be fully remote. This requirement does not apply to candidates residing in other states. This position is full-time (40 hours/week) Monday-Friday from 8:00am-4:30pm EST or 8:30am-5:00pm EST and will be fully remote. To work from home, you must have high-speed (non-satellite) internet and a private, secure home office.

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 an RN OR 2 years' case manager experience as an 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, Behavioral health, and Case Management.)
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, LiveOps, 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.