Remote RN Case Manager: Care Coordination & Outcomes

Southcarolinablues; Northern (KY); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health plans

401k retirement plan with match

Life Insurance

PTO

Job summary

BlueCross BlueShield of South Carolina is hiring a Case Management Coordinator to improve care coordination and reduce fragmentation in care for members, with a focus on safety, well-being, and cost-effective care. The role involves assessment, planning, facilitation, coordination, monitoring, and advocacy in collaboration with providers and families.

The position is full-time, 40 hours/week, typically 8:00am-5:00pm EST, fully remote in South Carolina, with occasional on-site trainings.

Qualifications

• Associates degree or equivalent; nursing graduates with related experience also acceptable.
• 4 years of recent clinical work in defined specialty or 4 years in utilization review/case management.
• Excellent verbal and written communication, and strong customer service skills.

Responsibilities

• Provides active care management, assesses service needs, develops action plans with members, and monitors services.
• Evaluates outcomes, eligibility, benefits, and medical necessity for services and exceptions.
• Ensures accurate clinical documentation to support medical necessity and contracts.
• Offers telephonic support for high-risk members and uses motivational interviewing techniques.
• Educates members and providers about care delivery systems, networks, and benefits.
• Promotes enrollment in care & disease management programs.
• Performs referrals to appropriate staff and participates in data collection for claims adjudication.

Skills

Word processing

Quality improvement

Contract language

Independent work

Customer service

Organizational skills

Presentation skills

Communication accuracy

Analytical thinking

Discretion

Education

Associate degree in a job-related field

Graduate of Accredited School of Nursing or 2 years related experience

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is hiring a Case Management Coordinator to improve care coordination and reduce fragmentation in care for members, with a focus on safety, well-being, and cost-effective care. The role involves assessment, planning, facilitation, coordination, monitoring, and advocacy in collaboration with providers and families.

The position is full-time, 40 hours/week, typically 8:00am-5:00pm EST, fully remote in South Carolina, with occasional on-site trainings.