For Select Community & Katie Beckett: 2 years experience in IDD for Select Community is required
Skills\Certifications
Excellent oral and written communication skills
PC Skills required (Basic Microsoft Office and E-Mail)
*The definition for "routine basis" is defined as daily, weekly or at regularly schedule times.
Number of Openings Available
1
Worker Type:
Employee
Company:
VSHP Volunteer State Health Plan, Inc
Applying for this job indicates your acknowledgement and understanding of the following statements:
Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:
BCBST's EEO Policies/Notices
Benefits
Health insurance
Additional Information
The High-Cost Claim team at BCBST is seeking a compassionate and highly skilled RN Case Manager to support members with advanced and multifaceted healthcare needs.
In this role, you will provide comprehensive, member-centered care for individuals with complex and chronic conditions, including high-risk diagnoses, through a proactive, advocacy-driven approach. You will collaborate across multidisciplinary teams to coordinate care, reduce barriers, and improve health outcomes while supporting cost-effective utilization of services and reducing unnecessary ED and inpatient utilization.
Success in this position requires the ability to manage a dynamic caseload with strong critical thinking, attention to detail, and exceptional telephonic and digital communication skills.
The ideal candidate brings a strong clinical foundation combined with care coordination expertise, including:
Experience in acute care settings such as ED, ICU, or Med-Surg
Background in case management, transitions of care, or discharge planning
Experience supporting members with complex needs is highly valued, including:
Chronic conditions (e.g., CHF, COPD, diabetes)
Behavioral health needs
Home and community-based care
This experience strengthens the ability to develop effective discharge plans and prevent avoidable readmissions.
Candidates should also demonstrate the ability to:
Assess and manage complex needs in a telephonic and digital environment
Navigate care across the continuum
Effectively engage members to drive adherence and outcomes
Strong technical proficiency is essential, along with a willingness to leverage enterprise-approved digital and AI tools to enhance care delivery, documentation, and operational efficiency.
Job 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.
Effective 7/22/13: 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.
Job Qualifications
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.
Bcbst · TN, Chattanooga, Remote