RN Concierge Care Manager - Case Manager

BlueCross BlueShield of South Carolina-posted 2 days ago
Full-time • Mid Level
Remote
5,001-10,000 employees
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Position Purpose 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.

  • 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.
  • Required Education: Associate’s degree in nursing OR Graduate of Accredited School of Nursing OR master’s degree in social work, Psychology, or Counseling.
  • Required Work Experience: 5 years' case management experience as an RN OR 2 years’ case manager experience as an RN in a health insurance environment.
  • Required Skills and Abilities: 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.
  • Required Software and Tools: Microsoft Office
  • Required Licenses and Certificates: 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. Nationally recognized Case Management certification to be obtained within 2 years of hire as a Case Manager.
  • Preferred Education: Bachelor's degree in health-related field (Nursing, Healthcare Administration, Pharmacy, Sciences, Applied Health)
  • Preferred Work Experience: 5 years’ experience in case management in a sub-specialty area (i.e. ICU, Palliative Care, Hospice, or Home Health)
  • Preferred Skills and Abilities: 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.
  • Preferred Software and Tools: Working knowledge of Microsoft Word, PowerPoint, Excel, or other spreadsheet/database software; TMCS, LiveOps, MDDS, and BlueVue.
  • Preferred Licenses and Certificates: Case manager certification, clinical certification in specialty area. Basic Life Support (BLS) or Advanced Cardiac Life Support (ACLS) certification.
  • Subsidized health plans, dental and vision coverage
  • 401k retirement savings plan with company match
  • Life Insurance
  • Paid Time Off (PTO)
  • On-site cafeterias and fitness centers in major locations
  • Education Assistance
  • Service Recognition
  • National discounts to movies, theaters, zoos, theme parks and more
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