Medical Case Manager (Hamblen, Greene County)

BlueCross BlueShield of Tennessee, Inc.; Chattanooga (TN); Remote; USD 65,000 - 90,000; Full time

Job summary

BlueCross BlueShield of Tennessee, Inc. seeks a Registered Nurse Case Manager to support utilization management and care coordination for members.

The role requires an active Tennessee RN license, 5 years in healthcare (3 in clinical settings), and travel to Hamblen or Greene counties as needed. The NCM collaborates with members, caregivers, and providers to develop integrated care plans and monitor progress.

Qualifications

• Active RN license in Tennessee or license in the state of residence if state participates in the Nurse Licensure Compact.
• 5 years of experience in the healthcare field, including 3 years of clinical experience.
• 2 years experience in IDD for Select Community is required.
• Excellent oral and written communication skills.
• Proficiency with Microsoft Office suite and email tools.

Responsibilities

• Support utilization management for complex/non-routine cases.
• Act as liaison between members, providers and internal/external customers for health care delivery and benefits.
• Oversee highly complex cases to ensure interventions are implemented and benefits are utilized efficiently.
• Perform essential case management activities: assessment, planning, implementation, coordinating, monitoring, outcomes and evaluation.
• Communicate effectively via digital channels and provide technical support as needed.

Skills

Oral communication

Written communication

Clinical experience

Tools

MS Office

Email

Job description

SelectCommunity at BCBST is seeking a Registered Nurse Case Manager who is compassionate about case management, advocating for social, emotional, functional, mental, behavioral, and physical health of those who are intellectually and developmentally disabled. In this role, the SelectCommunity Nurse Care Manager (NCM) assesses members' current status, facilitates coordination of long-term services and supports under their insurance benefits and benefits under Department of Disability and Aging. The SelectCommunity NCM collaborates with members, caregivers, conservators, and providers to develop individual, integrated plans of care based on health needs, while monitoring progress for members with multiple levels of acuity. The role requires telephonic contacts and in person home visits with members on at least a monthly basis and as required by TennCare Contract. You will be a great match for this role if you have an active RN license in the state of Tennessee along with 5 years of experience in the healthcare field (including 3 years of clinical experience). Additionally, we’re seeking candidates who reside in Hamblen or Greene County TN as travel is required to meet with members.

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. Job Qualifications:

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)
• 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

As Tennessee's largest health benefit plan company, we've been helping Tennesseans find their own unique paths to good health since 1945. More than that, we're your neighbors and friends – fellow Tennesseans with deep roots of caring tradition, a focused approach to physical, financial and community good health for today, and a bright outlook for an even healthier tomorrow. At BCBST, we empower our employees to thrive both independently and collaboratively, creating a collective impact on the lives of our members. We seek talented individuals who excel in a team environment, share responsibility, and embrace accountability. We're also seeking candidates who are proficient in the Microsoft Office suite, including Microsoft Teams, organized, and capable of managing multiple assignments or projects simultaneously. Additional, strong interpersonal abilities along with strong oral and written communication skills are important across all roles at BCBST. We foster a culture where innovation is encouraged. That includes using AI enabled tools responsibly to support everyday work — guided by proven workflows, templates, and policies. As roles become more advanced, we expect employees to leverage AI more broadly to transform how we serve members. BCBST is a remote-first organization with many employees working primarily from their homes. Each position within the company is classified as either fully remote, partially remote, or office based. BCBST hires employees for remote positions from across the U.S. with the exception of the following states: California, Massachusetts, New Hampshire, New Jersey, and New York. Applicants living in these states may move to an approved state prior to starting a position with BCBST at their own expense. If the position requires the individual to reside in Chattanooga, TN, they may be eligible for relocation assistance.