Pediatric Nurse Case Manager- Katie Beckett (Middle-South TN)

BlueCross BlueShield of Tennessee; Oregon; Hybrid; USD 65,000 - 90,000; Full time

Job summary

VSHP Volunteer State Health Plan, Inc. is seeking a Nurse Care Manager with pediatric experience to support children under 18 with disabilities and complex medical needs in their homes and communities. The role involves coordinating care, conducting visits, and developing support plans.

Ideal candidates will travel for face-to-face member meetings and reside in the service counties listed. Strong communication, organization, and attention to detail are essential for success in this position.

Qualifications

• Registered Nurse (RN) with an active license in Tennessee or a state participating in the Nurse Licensure Compact.
• Minimum of 3 years clinical experience; 5 years health care industry experience.
• Excellent oral and written communication skills; ability to use standard office software.

Responsibilities

• Manage a caseload of multiple complex pediatric members’ needs.
• Conduct member visits including home visits and adhere to contract timelines.
• Perform new member visits and ongoing assessments.
• Develop and maintain Person-Centered Support Plans.
• Coordinate with private insurance (TPL) and Medicaid to ensure services are covered.

Skills

Communication

PC Skills

Education

Registered Nurse license (TN or NLC state)

Tools

Microsoft Office

Job description

Join Our Team as a Nurse Care Manager with the Katie Beckett ProgramAre you passionate about supporting children under the age of 18 with disabilities and/or complex medical needs as they grow and thrive in their homes and communities? Katie Beckett is seeking a dedicated Nurse Care Manager with pediatric experience to join our team.

Key Responsibilities

• Manage a caseload of multiple complex pediatric members needs
• Conduct member visit including home visits by meeting timelines within the requirements set forth by our contract
• Perform new member visit and ongoing assessments
• Develop and maintain Person Centered Support Plans
• Collaborate with private insurance (TPL) and Medicaid to coordinate care to ensure that members needs are being met, and services are covered by the appropriate payor source

You will be a great match for this role if you have solid pediatric experience, strong communication, and organizational skills, as well as attention to detail and ability to create efficient, consistent, and accountable habits. The Nurse Care Manager will need to be flexible and adaptable in various situations and willing to travel for face‑to‑face meetings with members. Ideal candidates will live in one of the following counties: Marshall, Bedford, Coffee, Maury, Mt Juliet, Murfreesboro, Rutherford, Sparta, Warren & Williamson.

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 QualificationsLicense

• 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)

Qualified candidate will have pediatric experience preferably from an acute care setting, with demonstrated clinical expertise in caring for medically fragile children with complex medical and/or behavioral health needs. The Nurse Care Manager will assess for child development and milestones to provide resources for deficiencies identified. The Nurse Care Manager will identify goals and challenges through the person and family‑centered planning process and identify needed home and community‑based services; as well as, coordinate additional Medicaid benefits to include medical and behavioral health services which may not be covered through the child's primary payer .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 1Worker Type: EmployeeCompany: VSHP Volunteer State Health Plan, Inc

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