Remote Case Management Specialist

001 BlueCross and BlueShield of South Carolina; South Carolina; Hybrid; USD 55,000 - 85,000; Full time

Benefits offered by this job

Subsidized health plans

Dental and vision coverage

401k retirement savings plan with 401k

Life Insurance

PTO

Education Assistance

Service Recognition

National discounts

Job summary

BlueCross BlueShield of South Carolina is seeking a Case Management Coordinator to enhance care coordination and reduce fragmentation across care settings. The role emphasizes assessment, planning, facilitation, and advocacy to improve outcomes and reduce costs for members in a fully remote South Carolina position.

The candidate will conduct telephonic education, coordinate with providers, and ensure documentation supports medical necessity and benefits.

Qualifications

• Associates degree in a related field or equivalent experience.
• Experience with quality improvement processes and contract language.
• Ability to work independently, prioritize, and make sound decisions.
• Strong spelling, punctuation, and grammar skills.
• Excellent written and oral communication skills.
• Ability to persuade, negotiate, or influence others.
• Analytical or critical thinking abilities.

Responsibilities

• Provide active care management, assess service needs, and develop action plans with members.
• Monitor services, evaluate outcomes, and ensure medical necessity criteria.
• Document clinical information to support coverage and benefits decisions.
• Offer telephonic member support and coaching using motivational interviewing techniques.
• Coordinate with providers and facilities, promote enrollment in care management programs.
• Ensure compliant communications and data entry for proper claims adjudication.

Skills

Word processing

Quality improvement

Contract language

Independent work

Communication skills

Analytical thinking

Discretion with sensitive info

Microsoft Office

Education

Associates in related field

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is seeking a Case Management Coordinator to enhance care coordination and reduce fragmentation across care settings. The role emphasizes assessment, planning, facilitation, and advocacy to improve outcomes and reduce costs for members in a fully remote South Carolina position.

The candidate will conduct telephonic education, coordinate with providers, and ensure documentation supports medical necessity and benefits.