RN Concierge Care Manager - Medical 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

Summary

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina ... and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Description

We are currently hiring for an RN Concierge Care Manager to join BlueCross BlueShield of South Carolina. In this role as an RN Concierge Care Manager, you will provide care management services to more than 2 million members in South Carolina and nationally, administer complex, high-touch concierge case management for members identified into specialized programs such as high-risk maternity, NICU, ESRD, Cancer, Palliative Care or Behavioral Health, identify risks and provides outreach services to facilitate the coordination of healthcare services and gap closure, and provide individualized care plans to ensure cost-effectiveness, overall care satisfaction, and improved quality of life.

Location

This position is full-time (40 hours/week) Monday-Friday from 8:00am-5:00pm EST and will be fully remote. The candidate will be required to work two evenings a month to 8:00pm. To work from home, the candidate must have high-speed (non-satellite) internet and a private, secure home office.

Sponsorship

Sponsorship: This position is not eligible for sponsorship now or in the future.

Job Details

This position will be fully remote on a desktop computer to provide highly interactive case management to assigned members. Members will include those with chronic or high-risk conditions and those who are admitted to inpatient care. You will educate and guide members through prior authorizations and understanding the need to adhere to medications and the plan of care. Most interactions will be by phone and through our messaging system, perfect for those who love case management and improving the lives and medical outcomes of members while working in your own home office.

What You'll Do

• Directs day-to-day, high-touch member management to include implementation of program goals, coordination of treatment plans and benefit coordination for high-risk patient populations and/or those with complex conditions.
• Coordinates clinical services with external sources to include: providers, vendors, facilities, social workers/case managers and/or community services.
• Participates in team training and continuing medical education.
• Prepares for external audits and quality assurance efforts.

To Qualify for This Position, You'll Need the Following:

• Required Education: Associate's degree in nursing OR Graduate of Accredited School of Nursing OR master's degree in social work, Psychology, or Counseling.
• Required Work Experience: 5 years' case management experience as an RN OR 2 years' case manager experience as an RN in a health insurance environment.
• Required Skills and Abilities:
  • Working knowledge of word processing software.
  • Knowledge of quality improvement processes and demonstrated ability with these activities.
  • Knowledge of contract language and application.
  • Ability to work independently, prioritize effectively, and make sound decisions.
  • Demonstrated customer service, organizational, and presentation skills.
  • Demonstrated proficiency in spelling, punctuation, and grammar skills.
  • Demonstrated oral and written communication skills.
  • Ability to persuade, negotiate, or influence others.
  • Analytical or creative thinking skills.
  • Ability to handle confidential or sensitive information with discretion.
• Required Software and Tools: Microsoft Office
• Required Licenses and Certificates: Active, unrestricted RN licensure from the United States and in the state of hire; OR active, compact, multistate, unrestricted RN license as defined by the Nurse Licensure Compact (NLC); OR active licensure as a social worker, psychologist, or counselor in state of hire. Nationally recognized Case Management certification to be obtained within 2 years of hire as a Case Manager.

We Prefer That You Have the Following:

• Preferred Education: Bachelor's degree in health-related field (Nursing, Healthcare Administration, Pharmacy, Sciences, Applied Health)
• Preferred Work Experience: 5 years' experience in case management in a sub-specialty area (i.e. ICU, Palliative Care, Hospice, or Home Health)
• Preferred Skills and Abilities: Strong communication and customer services skills.
• Excellent analytical skills to problem solve and remedy issues immediately.