Concierge Care Manager

BlueCross BlueShield of South Carolina; South Carolina; Remote; USD 60,000 - 75,000; Full time

Job summary

A leading healthcare organization seeks a full-time Case Manager to coordinate treatment and manage complex patient populations. The ideal candidate will have a nursing or social work background, along with significant case management experience. This remote position offers competitive compensation and comprehensive benefits, including a 401(k) retirement plan, health coverage, and continuous education funding. Join us to make a meaningful impact in patient care and support.

Benefits

401(k) retirement savings plan with company match

Subsidized health plans and free vision coverage

Paid annual leave

Nine paid holidays

Tuition assistance

Continuing education funds for certifications

Qualifications

• Five years' case management experience as a RN OR two years’ case manager experience as a RN in a health insurance environment.
• Active, unrestricted RN licensure from the United States or a social worker/counselor license.
• Nationally recognized case management certification to be obtained within two years.

Responsibilities

• Directs day-to-day member management and implements program goals.
• Coordinates clinical services with providers and community services.
• Prepares for external audits and quality assurance.

Skills

Customer service

Analytical thinking

Communication

Organizational skills

Negotiation

Education

Associate’s degree in Nursing

Master's degree in Social Work, Psychology, or Counseling

Tools

Microsoft Office

Job description

Logistics : This position is full time (40 hours / week) Monday-Friday and will be fully remote () .

What You Will Do :

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, including 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 Will Need :

Associate’s degree in Nursing; OR Graduate of Accredited School of Nursing; OR Master's degree in Social Work, Psychology, OR Counseling (Div. 75 and 6B only).

Five years' case management experience as a RN OR two years’ case manager experience as a RN in a health insurance environment.

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.

Microsoft Office.

Active, unrestricted RN licensure from the United States and in the state of hire; OR active, compact, multistate, unrestricted RN license as defined by the Nurse Licensure Compact (NLC); OR active licensure as a social worker, psychologist, OR counselor in state of hire (Div. 75 only).

Nationally recognized case management certification will be obtained within two years of hiring as a case manager.

What We Prefer :

Bachelor's degree in a health-related field (Nursing, Healthcare Administration, Pharmacy, Sciences, Applied Health).

Five years experience in case management in a sub-specialty area (i.e., ICU, Palliative Care, Hospice, OR Home Health).

Strong communication and customer service skills.

Excellent analytical skills to problem-solve and remedy issues immediately.

Ability to work in an autonomous environment OR leadership capacity.

Working knowledge of Microsoft Word, PowerPoint, Excel, OR other spreadsheet / database software; TMCS, LiveOps, MDDS, and BlueVue.

Case manager certification, clinical certification in a specialty area.

Basic Life Support (BLS) OR Advanced Cardiac Life Support (ACLS) certification.

What We Can Do for You

401(k) retirement savings plan with company match.

Subsidized health plans and free vision coverage.

Life insurance.

Paid annual leave – the longer you work here, the more you earn.

Nine paid holidays.

On-site cafeterias and fitness centers in major locations.

Wellness programs and healthy lifestyle premium discount.

Tuition assistance.

Service recognition.

Incentive Plan.

Merit Plan.

Continuing education funds for additional certifications and certification renewal.

What to Expect Next

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and salary requirements.

Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.