Remote RN Concierge Care Manager – High-Touch Case Management

BlueCross and BlueShield of South Carolina; United States; Remote; USD 90,000 - 120,000; Full time

Job summary

BlueCross BlueShield of South Carolina is seeking an RN Concierge Care Manager to provide high-touch care management for more than 2 million members nationwide, with a focus on high-risk maternity, NICU, ESRD, Cancer, Palliative Care or Behavioral Health.

This fully remote, full-time position requires coordinating with providers and external partners, guiding prior authorizations, and creating individualized care plans to improve outcomes from your home office.

Qualifications

• RN Concierge Care Manager role serving 2M+ members.
• Identify risks and coordinate care across services.
• Coordinate treatment plans and benefits for high‑risk patients.
• Educate and guide members on prior authorizations and plan of care.
• Most interactions via phone and our messaging system.

Responsibilities

• Direct high-touch member management and care plan coordination for high-risk patients.
• Coordinate clinical services with providers, vendors, facilities, social workers, and community services.
• Participate in team training and continuing medical education.
• Prepare for external audits and quality assurance efforts.

Skills

RN case management experience

RN case management in health insurance

Word processing

Quality improvement processes

Contract language knowledge

Independent work & prioritization

Customer service

Oral & written communication

Discretion with confidential info

Persuasion/negotiation

Analytical or creative thinking

Education

Associate's degree in nursing

Graduate of Accredited School of Nursing

Master's degree in social work, Psychology, or Counseling

Bachelor's degree in health-related field

Active RN licensure (US) or compact multistate licensure

Licensure as social worker, psychologist, or counselor

National Case Management certification (within 2 years)

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is seeking an RN Concierge Care Manager to provide high-touch care management for more than 2 million members nationwide, with a focus on high-risk maternity, NICU, ESRD, Cancer, Palliative Care or Behavioral Health.

This fully remote, full-time position requires coordinating with providers and external partners, guiding prior authorizations, and creating individualized care plans to improve outcomes from your home office.