Case Manager (Memphis)

BlueCross BlueShield of Tennessee; Memphis (TN); On-site; USD 65,000 - 100,000; Full time

Job summary

BlueCross BlueShield of Tennessee is hiring a Home Health Case Manager. You will coordinate home-based care for TennCare members, conduct home visits, and support transitions to adult benefits. Work remotely with travel to members' homes in the Memphis area and surrounding counties.

Required RN license in Tennessee, 3 years clinical experience, 5 years healthcare background, and familiarity with community-based services. Strong communication and digital literacy are essential for success.

Qualifications

• Excellent oral and written communication skills.
• PC Skills required (Basic Microsoft Office and E-Mail)

Responsibilities

• Support utilization management for complex cases as needed.
• Serve as liaison between members, providers and care teams.
• Oversee complex cases to ensure interventions and efficient benefits use.
• Perform essential case management activities: assessment, planning, coordination, monitoring, evaluation.

Skills

Excellent communication

Office software

Tools

Microsoft Office

Email

Job description

We are hiring a Home Health Case Manager at BCBST!

In this role, you will support TennCare (Medicaid) members with complex medical, functional and social needs. You will coordinate home and community-based care, conduct required home visits, and support members transitioning to adult benefits. You’ll collaborate closely with providers and internal care teams using digital tools to identify care gaps, reduce hospitalization risk, and improve outcomes.

To be successful in this role, in addition to the core job requirements, you'll bring strong clinical judgement, experience using digital tools to communication, and availability for home visits. You will be a strong candidate for this role if you have the following: home health or hospice nursing experience, pediatric experience, knowledge of MTLSS programs, and familiarity with community-based services.

Note:

• This is a remote, Monday-Friday (8:00 a.m.-5:00 p.m.) role with flexibility to support member needs, however this role requires traveling to members' homes in the Memphis area and surrounding counties.
• Candidates must live within 50 miles of Memphis.
• 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)

Preference will be given to candidates in cost center 338

Number of Openings Available

1

Worker Type:

Employee

Company:

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:

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