RN Medical Case Manager

BlueCross BlueShield of Tennessee; Chattanooga (TN); Remote; USD 65,000 - 90,000; Full time

Benefits offered by this job

Remote-first policy

Job summary

BlueCross BlueShield of Tennessee is hiring a remote-friendly RN Case Manager to support members with complex health needs. You will coordinate across multidisciplinary teams, navigate care, and advocate for cost-effective, high-quality outcomes.

The role emphasizes telephonic and digital communication, robust care planning, and leveraging enterprise digital tools to enhance delivery and documentation. A Tennessee RN license is required and the position allows remote work from across the U.S.

Qualifications

• RN with active TN license (or compact license per residence)
• 3 years clinical experience required
• 5 years health care industry experience
• 2 years IDD experience for Select Community/Katie Beckett

Responsibilities

• Support utilization management for complex cases.
• Liaise with members, providers and care teams to coordinate services.
• Oversee highly complex cases to ensure effective interventions and optimal benefit use.
• Conduct assessments, planning, implementation, coordination, monitoring, outcomes and evaluation.
• Communicate effectively via digital channels and provide tech support.

Skills

RN Case Manager

Telephonic communication

Digital literacy

Microsoft Office

Care coordination

Clinical assessment

Education

Registered Nurse (RN) license in TN

Tools

Microsoft Office

Job description

Remote

USA, TN, Chattanooga, Remote

Full time

R-51140

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.

Candidates should also demonstrate the ability to:

• Assess and manage complex needs in a telephonic and digital environment
• Navigate care across the continuum
• Effectively engage members to drive adherence and outcomes
• Strong technical proficiency is essential, along with a willingness to leverage enterprise-approved digital and AI tools to enhance care delivery, documentation, and operational efficiency.

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

Applying for this job indicates your acknowledgement and understanding of the following statements:

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 (https://www.bcbst.com/docs/equal-employment-opportunity.pdf)

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.