Medical Case Manager (Hamblen, Greene County)

BlueCross BlueShield of Tennessee; Nashville (TN); Hybrid; USD 65,000 - 90,000; Full time

Job summary

BlueCross BlueShield of Tennessee seeks a Registered Nurse Case Manager to advocate for and coordinate care for members in the SelectCommunity program. The NCM will perform telephonic reviews and monthly in-person home visits, coordinating long-term services under TennCare and disability programs, and developing integrated care plans with members, caregivers, and providers.

Required qualifications include an active Tennessee RN license, 3 years of clinical experience and 5 years in healthcare,

Qualifications

• Active RN license in the state of Tennessee.
• Excellent oral and written communication skills.
• Proficient in basic Microsoft Office and email.

Responsibilities

• Support utilization management for complex cases and coordinate health care delivery.
• Liaise between members, providers and internal/external customers to coordinate benefits.
• Oversee highly complex cases and implement interventions to ensure optimal utilization.
• Perform assessment, planning, implementation, coordination, monitoring and evaluation.
• Communicate effectively via digital channels and provide technical support.
• Commitment of 18 months before posting for other internal positions.
• Meet immunization and medical test requirements as needed.

Skills

Communication skills

Microsoft Office

Digital literacy

Education

RN license Tennessee

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. This 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
• 5 years of experience in the healthcare field (including 3 years of clinical experience)
• residence 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.
• 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.
• Experience: 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.

Posting Details

• 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