Medical Case Manager (Shelby County)

bcbst; Tennessee; On-site; USD 70,000 - 85,000; Full time

Job summary

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.

The role includes telephonic contacts and monthly in-person home visits, with travel to Shelby County TN as required by TennCare. Active Tennessee RN license and 5 years of healthcare experience (including 3 years clinical) are required.

Qualifications

• Active RN license in Tennessee
• 3 years clinical experience
• 5 years healthcare experience
• 2 years experience in IDD for Select Community (if applicable)

Responsibilities

• Supports utilization management for complex and non-routine cases as needed.
• Liaises between members, providers and internal/external stakeholders to coordinate care and benefits.
• Oversees highly complex cases to ensure effective interventions and appropriate benefit utilization.
• Performs core case management activities: assessment, planning, implementation, coordination, monitoring, outcomes and evaluation.
• Communicates digitally and provides technical support where needed.
• Complies with internal posting/assignment requirements and related policies.
• Adheres to immunization and health testing requirements as applicable.
• Completes digital literacy assessments as part of the role.

Skills

Case management

Communication skills

Clinical experience

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 along with 5 years of experience in the healthcare field (including 3 years of clinical experience). Additionally, we’re seeking candidates who reside in Shelby 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
• 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

Applying for this job indicates your acknowledgment 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.

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.