RN Concierge Care Manager – Case Management at BlueCross BlueShield of South Carolina

, , United States -

Full Time

Start Date

Immediate

Expiry Date

30 Jan, 26

Salary

0.0

Posted On

01 Nov, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Case Management, Patient Coordination, Healthcare Services, Communication Skills, Analytical Skills, Customer Service, Organizational Skills, Presentation Skills, Problem Solving, Confidentiality, Microsoft Office, Prior Authorization, Medication Adherence, Quality Improvement, Risk Identification, Outreach Services

Industry

Insurance

Description

Summary 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. Description 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. 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. Location 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. What You'll Do: 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. To Qualify for This Position, You'll Need the Following: Required Education: 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. 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 (Div. 75 only). Nationally recognized Case Management certification to be obtained within 2 years of hire as a Case Manager. We Prefer That You Have the Following: 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. Our Comprehensive Benefits Package Includes the Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits for the first of the month following 28 days of employment. 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 What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information. If you don’t have an account with us and don’t see the dream job you are looking for, click on the link above to Join Our Talent Community by submitting your resume and contact information and we will reach out if we find a good fit. Welcome Here’s Your Smart Career Move Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. Business and political climates may change, but we’re stronger than ever. Our A.M. Best rating is A+ (Superior) — making us the only health insurance company in South Carolina with that rating. We’re the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Veterans Welcome! BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We’ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more. Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson. If you are a full-time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty. Join Us If you're ready to join in a diverse company with secure, community roots and an innovative future, apply for a position now!

Responsibilities

The RN Concierge Care Manager will provide high-touch case management services to members with chronic or high-risk conditions. Responsibilities include coordinating treatment plans, implementing program goals, and facilitating healthcare services.