Managed Care Coordinator II/CM-DM (Maternity)

BlueCross BlueShield of South Carolina; United States; Remote; USD 50,000 - 80,000; Full time

Job summary

Join a forward-thinking healthcare organization as a Managed Care Coordinator II, where you'll play a vital role in enhancing client safety and well-being. This full-time remote position emphasizes care management interventions, ensuring seamless coordination of services and advocating for members with chronic conditions. With a commitment to community values and professional growth, this role offers a dynamic environment where your contributions will significantly impact the quality of life for clients. If you are passionate about making a difference in healthcare, this opportunity is for you.

Benefits

Health Insurance

Dental Insurance

Vision Insurance

401K with Match

Life Insurance

Paid Time Off (PTO)

Qualifications

• 4+ years of clinical experience in a specialty area or case management.
• Active RN license or social worker/counselor license required.

Responsibilities

• Provide active care management and develop action plans for members.
• Document clinical information accurately to support medical necessity.

Skills

Care Management

Assessment

Communication

Clinical Documentation

Patient Advocacy

Education

Associates Degree in a Related Field

Bachelor's Degree in Nursing

Tools

Excel

Access

Job description

Summary

We are currently hiring for a Managed Care Coordinator II/CM-DM to join BlueCross BlueShield of South Carolina. This role focuses on care management interventions to improve care coordination, reduce fragmentation of services, and enhance client safety, well-being, and quality of life. The position involves assessment, planning, facilitation, coordination, monitoring, evaluation, and advocacy, with an emphasis on collaboration and communication with clients, families, and healthcare professionals.

Why Join Us?

BlueCross BlueShield of South Carolina has a rich history of over seven decades, serving the community and leading in various healthcare and administrative areas. We offer a dynamic, secure, and innovative work environment rooted in community values.

Description

Logistics

This is a full-time (40 hours/week), remote position, Monday through Friday.

Responsibilities:

• Provide active care management, assess service needs, develop and coordinate action plans, monitor services, and evaluate outcomes.
• Document clinical information accurately to support medical necessity and benefits.
• Support members with chronic conditions or at-risk conditions through telephonic assessments, education, and coaching.
• Participate in direct interventions, patient education, and on-site reviews as needed.
• Serve as a member advocate, promote enrollment in management programs, and communicate with healthcare providers and members.
• Perform medical and behavioral review and authorization processes, ensuring coverage within guidelines.
• Identify and refer cases to appropriate staff, participate in data collection, and ensure compliance with applicable regulations.

Qualifications:

• Associates degree in a related field or equivalent experience, with at least four years of clinical experience in a specialty area or utilization review/case management.
• Knowledge of healthcare processes, quality improvement, and contract language.
• Ability to work independently, prioritize, and communicate effectively.
• Active RN license, or social worker/counselor license, with URAC Case Management Certification within four years if applicable.

Preferred Qualifications:

• Bachelor's degree in Nursing or related field.
• Knowledge of claims, coding, and software tools like Excel and Access.
• Clinical certification in a specialty area.

Benefits:

• Health, dental, vision insurance, 401K with match, life insurance, PTO, and other perks.

Our Commitment:

We value diversity and inclusion, offering opportunities for professional growth and contribution.

Next Steps:

Application review, possible interview, and selection process details are provided. We are an Equal Opportunity Employer and provide reasonable accommodations upon request.