Case Manager- Knoxville, TN

BlueCross BlueShield of Tennessee; Knoxville (TN); On-site; USD 65,000 - 90,000; Full time

Job summary

VSHP Volunteer State Health Plan, Inc, on the BlueCare Population Health Management Team at BCBST, seeks a Care Transition Case Manager to help members transition from hospital care to home and community settings.

You will perform face-to-face member visits, coordinate discharge planning with hospital teams, and arrange post-acute services to improve health outcomes. Travel to Knoxville-area hospitals is required.

Qualifications

• RN license in Tennessee (or state with compact license)
• 3 years clinical experience required
• 5 years experience in the health care industry, IDD experience for Select Community is required (2 years)

Responsibilities

• Support utilization management for complex/non-routine cases as needed.
• Liaise between members, providers and internal/external customers for care delivery and benefits.
• Oversee highly complex cases to ensure interventions and efficient use of benefits.
• Perform essential case management activities: assessment, planning, implementation, coordination, monitoring, evaluation.

Skills

Excellent oral and written коммуника?

Education

RN License in Tennessee

Job description

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.

• 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

• 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

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