RN Medical Case Manager

BlueCross BlueShield of Tennessee, Inc.; Chattanooga (TN); On-site; USD 65,000 - 90,000; Full time

Job summary

BlueCross BlueShield of Tennessee, Inc. seeks an RN Case Manager to support members with complex and chronic conditions. You will coordinate care, collaborate with multidisciplinary teams, and advocate for cost-effective service utilization while reducing unnecessary ED and inpatient use.

The role requires an RN license in TN, 3 years clinical experience, and strong communication skills. Experience with discharge planning and transitions of care is valued, and MS Office/MS Teams proficiency is

Qualifications

• Active RN license in Tennessee or a compact state.
• 2 years experience in IDD for Select Community is required.
• 3 years of clinical experience required.
• 5 years in the health care industry preferred.
• Excellent oral and written communication skills.
• Proficiency with Microsoft Office and MS Teams.

Responsibilities

• Support utilization management for complex, non-routine cases as needed.
• Serve as liaison between members, providers, and internal/external customers.
• Oversee highly complex cases to ensure effective interventions and efficient benefits use.
• Perform core case management activities: assessment, planning, implementation, coordination, monitoring, evaluation.
• Utilize digital channels to communicate and provide technical support.

Skills

Excellent communication

Telephonic communication

Digital communication

Care coordination

Microsoft Office

Microsoft Teams

Education

RN license in TN

Tools

Electronic Health Records (EHR) systems

Job description

The High-Cost Claim team at BCBST is seeking a compassionate and highly skilled RN Case Manager to support members with advanced and multifaceted healthcare needs. In this role, you will provide comprehensive, member-centered care for individuals with complex and chronic conditions, including high-risk diagnoses, through a proactive, advocacy-driven approach. You will collaborate across multidisciplinary teams to coordinate care, reduce barriers, and improve health outcomes while supporting cost-effective utilization of services and reducing unnecessary ED and inpatient utilization. Success in this position requires the ability to manage a dynamic caseload with strong critical thinking, attention to detail, and exceptional telephonic and digital communication skills. The ideal candidate brings a strong clinical foundation combined with care coordination expertise, including: Experience in acute care settings such as ED, ICU, or Med-Surg Background in case management, transitions of care, or discharge planning Experience supporting members with complex needs is highly valued, including: Chronic conditions (e.g., CHF, COPD, diabetes) Behavioral health needs Home and community-based care This experience strengthens the ability to develop effective discharge plans and prevent avoidable readmissions.

Job Responsibilities

• Supporting utilization management functions for more complex and non-routine cases as needed.
• Serving as a liaison between members, providers and internal/external customers in coordination of health care delivery and benefits programs.
• Overseeing highly complex cases identified through various mechanisms to ensure effective implementation of interventions, and to ensure efficient utilization of benefits.
• Performing the essential activities of case management: assessment: planning, implementation, coordinating, monitoring, outcomes and evaluation.
• Digital positions must have the ability to effectively communicate via digital channels and offer technical support.
• Effective 7/22/13: This Position requires an 18 month commitment before posting for other internal positions.
• Various immunizations and/or associated medical tests may be required for this position.
• This job requires digital literacy assessment.

Job Qualifications

• License Registered Nurse (RN) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law.
• Experience 3 years - Clinical experience required.
• 5 years - Experience in the health care industry.
• For Select Community & Katie Beckett: 2 years experience in IDD for Select Community is required.
• Skills\Certifications Excellent oral and written communication skills.
• PC Skills required (Basic Microsoft Office and E-Mail).
• N/A Number of Openings Available 1.
• Worker Type: Employee.
• Company: VSHP Volunteer State Health Plan, Inc.

BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page: BCBST's EEO Policies/Notices

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity.

All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

As Tennessee's largest health benefit plan company, we've been helping Tennesseans find their own unique paths to good health since 1945. More than that, we're your neighbors and friends – fellow Tennesseans with deep roots of caring tradition, a focused approach to physical, financial and community good health for today, and a bright outlook for an even healthier tomorrow.

At BCBST, we empower our employees to thrive both independently and collaboratively, creating a collective impact on the lives of our members. We seek talented individuals who excel in a team environment, share responsibility, and embrace accountability. We're also seeking candidates who are proficient in the Microsoft Office suite, including Microsoft Teams, organized, and capable of managing multiple assignments or projects simultaneously. Additional, strong interpersonal abilities along with strong oral and written communication skills are important across all roles at BCBST.

We foster a culture where innovation is encouraged. That includes using AI enabled tools responsibly to support everyday work - guided by proven workflows, templates, and policies. As roles become more advanced, we expect employees to leverage AI more broadly to transform how we serve members.

BCBST is a remote-first organization with many employees working primarily from their homes. Each position within the company is classified as either fully remote, partially remote, or office based. BCBST hires employees for remote positions from across the U.S. with the exception of the following states: California, Massachusetts, New Hampshire, New Jersey, and New York. Applicants living in these states may move to an approved state prior to starting a position with BCBST at their own expense. If the position requires the individual to reside in Chattanooga, TN, they may be eligible for relocation assistance.