RN Concierge Care Manager

About the role

Provides care management services to more than 2 million members in South Carolina and nationally. Administers 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. Identifies risks and provides outreach services to facilitate the coordination of healthcare services and gap closure. Provides individualized care plans to ensure cost-effectiveness, overall care satisfaction, and improved quality of life. Position Purpose We are currently hiring for an RN Concierge Care Manager to join BlueCross BlueShield of South Carolina. In this role as an RN Concierge Care Manager, 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. Location This position is full-time (40 hours/week) Monday-Friday from 8:00am-5:00pm EST and will be fully remote. To work from home, the candidate must have high-speed (non-satellite) internet and a private, secure home office. 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 aid in your consideration, please attach a copy of your current RN license, or include your RN license number on your resume.

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.
• 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.
• 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
• 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 certificati

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