RN Concierge Care Manager - Medical Case Management

BlueCross BlueShield of South Carolina•W@H South Carolina, SC

4d•$57,790 - $110,388•Remote

About The Position

BlueCross BlueShield of South Carolina is hiring an RN Concierge Care Manager to provide care management services to members in South Carolina and nationally. The role delivers complex, high-touch concierge case management for members in specialized programs such as high-risk maternity, NICU, ESRD, cancer, palliative care, or behavioral health. The manager identifies risks, conducts outreach to coordinate healthcare services and close care gaps, and develops individualized care plans to support cost-effectiveness, member satisfaction, and quality of life. The position provides highly interactive case management remotely using a desktop computer. Assigned members may have chronic or high-risk conditions or be receiving inpatient care. The manager educates and guides members through prior authorizations and helps them understand the importance of adhering to medications and care plans. Most interactions take place by phone and through the company messaging system. This is a full-time, fully remote position working Monday through Friday, 8:00 a.m. to 5:00 p.m. Eastern Time, with two evenings per month extending to 8:00 p.m. The employee must have high-speed, non-satellite internet and a private, secure home office. The position is not eligible for sponsorship.

Requirements

Associate’s degree in nursing, graduation from an accredited school of nursing, or a master’s degree in social work, psychology, or counseling.
Five years of case management experience as an RN, or two years of RN case manager experience 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 its application.
Ability to work independently, prioritize effectively, and make sound decisions.
Demonstrated customer service, organizational, and presentation skills.
Proficiency in spelling, punctuation, and grammar.
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 skills.
Active, unrestricted U.S. RN licensure in the state of hire, an active compact multistate unrestricted RN license under the Nurse Licensure Compact, or active licensure as a social worker, psychologist, or counselor in the state of hire.
Obtain nationally recognized Case Management certification within two years of hire as a Case Manager.
For remote work, high-speed non-satellite internet and a private, secure home office are required.

Nice To Haves

Bachelor’s degree in a health-related field, such as nursing, healthcare administration, pharmacy, sciences, or applied health.
Five years of case management experience in a subspecialty area such as ICU, palliative care, hospice, or home health.
Strong communication and customer service skills.
Excellent analytical skills to solve problems and remedy issues promptly.
Ability to work autonomously or in a leadership capacity.
Working knowledge of Microsoft Word, PowerPoint, Excel, or other spreadsheet or database software; TMCS, LiveOps, MDDS, and BlueVue.
Case manager certification or clinical certification in a specialty area.
Basic Life Support (BLS) or Advanced Cardiac Life Support (ACLS) certification.

Responsibilities

Direct day-to-day, high-touch member management, including implementation of program goals, coordination of treatment plans, and benefit coordination for high-risk populations and members with complex conditions.
Coordinate clinical services with external providers, vendors, facilities, social workers, case managers, and community services.
Identify member risks and provide outreach to coordinate healthcare services and close care gaps.
Develop individualized care plans that support cost-effectiveness, care satisfaction, and improved quality of life.
Educate and guide members through prior authorizations and adherence to medications and care plans.
Participate in team training and continuing medical education.
Prepare for external audits and quality assurance efforts.