Remote Case Management Specialist

Socket.dev; United States; Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Subsidized health plans

401k retirement savings plan with公司匹配

Life Insurance

Paid Time Off (PTO)

On-site cafeterias and fitness centers

Job summary

BlueCross BlueShield of South Carolina is hiring a Case Management Coordinator to enhance care coordination and reduce fragmentation for recipients of care. The role demands active care management, assessment, planning, facilitation, and advocacy with collaboration across care teams.

The ideal candidate holds an active RN license or social work/counselor/psychologist licensure, plus 4 years of clinical or utilization review experience; strong MS Office skills are required.

Qualifications

• Associates in a job related field.
• Degree Equivalency: 2 years job related work experience.
• 4 years recent clinical in defined specialty area (oncology, cardiology, neonatology, maternity, rehabilitation, mental health/chemical dependency, orthopedic, general medicine/surgery) or 4 years utilization review/case management/clinical.
• Working knowledge of word processing software.
• Knowledge of quality improvement processes.
• Knowledge of contract language and its application.
• Ability to work independently, prioritize effectively, and make sound decisions.
• Good judgment skills.
• Demonstrated customer service, organizational and presentation skills.
• Demonstrated proficiency in spelling, punctuation and grammar; oral and written communication.
• Ability to persuade, negotiate or influence others.
• Analytical or critical thinking skills.
• Ability to handle confidential or sensitive information with discretion.
• Required Software and Tools: Microsoft Office.

Responsibilities

• Provides active care management, assesses service needs, develops and coordinates action plans with members, monitors services, and evaluates outcomes.
• Participates in direct intervention/education with members and providers regarding health care delivery, utilization on networks and benefit plans.
• Provides appropriate communications (written, telephone) regarding services to providers and members.
• Performs medical or behavioral review/authorization, ensures coverage within guidelines, and refers to appropriate staff.
• Maintains knowledge of contracts and network status; assists with claims information and resolution.

Skills

Independent work

Prioritization

Decision making

Communication skills

Analytical thinking

Discretion with confidential info

Customer service

Oral and written communication

Persuasion/negotiation

Team collaboration

Education

Associates in a related field

Degree equivalency: 2 years related experience

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is hiring a Case Management Coordinator to enhance care coordination and reduce fragmentation for recipients of care. The role demands active care management, assessment, planning, facilitation, and advocacy with collaboration across care teams.

The ideal candidate holds an active RN license or social work/counselor/psychologist licensure, plus 4 years of clinical or utilization review experience; strong MS Office skills are required.