Medical Case Manager

BlueCross BlueShield of Tennessee; United States; Remote; USD 65,000 - 85,000; Full time

Job summary

BlueCross BlueShield of Tennessee recherche des Infirmiers(ères) Médicaux pour rejoindre leur équipe dynamique. Les responsabilités incluent le soutien à la gestion des soins pour des membres avec des conditions chroniques et la coordination efficace des soins. Un engagement à long terme et d'excellentes compétences en communication sont essentiels pour exceller dans ce rôle à distance.

Qualifications

• Infirmier(ère) inscrit(e) dans l'État du Tennessee ou dans un État participant au Compact Lifesaver.
• 3 ans d'expérience clinique requise.
• 5 ans d'expérience dans le secteur de la santé.

Responsibilities

• Support des fonctions de gestion de l'utilisation pour des cas complexes.
• Servir de liaison entre membres et fournisseurs.
• Évaluation, planification et mise en œuvre des interventions.

Skills

Communication

Gestion de cas

Problème de résolution

Compétences PC

Education

Licence en soins infirmiers

Job description

BlueCross BlueShield of Tennessee (BCBST) is seeking four (4) skilled and compassionate Registered Nurses to join our fast-paced, high-performing team. These Medical Case Manager roles focus on supporting members with chronic health conditions, working alongside them and their providers to ensure timely, coordinated, and effective care.

Our ideal candidates will be energized by engaging and connecting with members over the phone and through digital channels. They will find fulfillment in supporting our members through clear communication and proactive problem-solving. Whether it’s guiding someone through a complex issue or simply offering a reassuring voice, our team members excel at making meaningful connections and delivering exceptional service with every interaction.

To thrive on this fully remote team, you’ll need to be tech savvy, adaptable, and experienced in managing complex patient needs. Experience supporting patients with chronic conditions such as Asthma, Coronary Artery Disease (CAD), Congestive Heart Failure (CHF), Chronic Obstructive Pulmonary Disease (COPD), and/or Diabetes is highly preferred.

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

• Currently has a Certified Case Manager (CCM) credential or must obtain certification within 2 years of hire.
• For Select Community & Katie Beckett: In addition to CCM, Certification in Developmental Disabilities Nursing (CDDN)is required at hire, or must be attained within 3 years.
• 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:

BCBST BlueCross BlueShield of Tennessee, 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

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.

Tobacco-Free Hiring Statement

To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits. A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco/nicotine test. An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotine and/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results.

Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW.