Case Manager- Knoxville, TN

BlueCross BlueShield of Tennessee; Knoxville (TN); Remote; USD 65,000 - 95,000; Full time

Job summary

VSHP Volunteer State Health Plan, Inc in Tennessee is hiring a Care Transition Case Manager to support safe discharge planning and post-acute care coordination for members with complex health needs. You will work with hospital staff, physicians, and internal teams to ensure seamless transitions from acute care to home and community-based services.

The role requires travel to Knoxville-area hospitals at least one day per week, strong clinical judgment, time management, and excellent communication

Qualifications

• Registered Nurse (RN) with active Tennessee license or Compact state license.
• 3 years clinical experience required.
• 5 years experience in the health care industry.
• For Select Community & Katie Beckett: 2 years in IDD experience.

Responsibilities

• Support utilization management for complex cases.
• Liaise between members, providers and care teams.
• Oversee highly complex cases to ensure interventions and benefits utilization.
• Perform evaluation and coordination across planning, implementation and monitoring.
• Digital communication proficiency and support capabilities.
• 18 month commitment before posting for other internal positions.
• Immunizations/multiple medical tests may be required.

Skills

Excellent oral and written

Communication

PC skills

Job description

Remote - Location Specific

USA, TN, Knoxville, Remote

Full time

R-51564

We are hiring a Care Transition Case Manager on the BlueCare Population Health Management Team at BCBST!

Are you passionate about helping individuals successfully transition from hospital care back to their homes and communities? In this role, you will support members with complex healthcare needs by ensuring safe, effective discharge planning and coordinated post-acute care. You'll partner closely with members, hospital staff, physicians, specialists, and internal care teams to identify needs, remove barriers to care, and connect members with the resources necessary to achieve better health outcomes.

As a Care Transition Case Manager, you will have a direct impact on reducing gaps in care and supporting members through critical transitions. You will conduct face-to-face visits with members in area hospitals, collaborate with hospital care teams on discharge planning, and coordinate services that promote a smooth and informed transition from acute care settings to home and community-based care.

To be successful in this role, in addition to the core job requirements, you'll bring strong clinical judgment, critical thinking abilities, exceptional time management skills, and the ability to effectively prioritize competing responsibilities in a fast-paced environment. Ideal candidates will have experience in home health, community-based nursing, public health or health department settings, and/or community hospitals. Candidates who are self-motivated, collaborative, and passionate about improving member outcomes will thrive on this team.

Note:

• Location Requirements: This role requires travel to Knoxville-area hospitals for a minimum of one day per week to conduct in-person member visits and collaborate directly with facility staff. As such, candidates will need to live within 50 miles of Knoxville, TN.

• Sponsorship is not available for this role.

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.

Experience

• 3 years - Clinical experience required
• 5 years - Experience in the health care industry
• 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)

Employees who are required to operate either a BCBST-owned vehicle or a personal or rental vehicle for company business on a routine basis* will be automatically enrolled into the BCBST Driver Safety Program. The employee will also be required to adhere to the guidelines set forth through the program. This includes, maintaining a valid driver’s license, auto insurance compliance with minimum liability requirements; as defined in the “Use of Non BCBST-Owned Vehicle” Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR).*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:

BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin,citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices (https://www.bcbst.com/docs/equal-employment-opportunity.pdf)

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

As Tennessee's largest health benefit plan company, we've been helping Tennesseans find their own unique paths to good health since 1945. More than that, we're your neighbors and friends – fellow Tennesseans with deep roots of caring tradition, a focused approach to physical, financial and community good health for today, and a bright outlook for an even healthier tomorrow.

At BCBST, we empower our employees to thrive both independently and collaboratively, creating a collective impact on the lives of our members. We seek talented individuals who excel in a team environment, share responsibility, and embrace accountability.

We're also seeking candidates who are proficient in the Microsoft Office suite, including Microsoft Teams, organized, and capable of managing multiple assignments or projects simultaneously. Additional, strong interpersonal abilities along with strong oral and written communication skills are important across all roles at BCBST.

We foster a culture where innovation is encouraged. That includes using AI enabled tools responsibly to support everyday work — guided by proven workflows, templates, and policies. As roles become more advanced, we expect employees to leverage AI more broadly to transform how we serve members.

BCBST is a remote-first organization with many employees working primarily from their homes. Each position within the company is classified as either fully remote, partially remote, or office based.

BCBST hires employees for remote positions from across the U.S. with the exception of the following states: California, Massachusetts, New Hampshire, New Jersey, and New York. Applicants living in these states may move to an approved state prior to starting a position with BCBST at their own expense.If the position requires the individual to reside in Chattanooga, TN, they may be eligible for relocation assistance.