RN Concierge Care Manager – Medical Case Management

🕒 5 dias atrás

🌴 South Carolina – Remoto

🌴 South Carolina – Remote

💵 $57.790 - $110.388 / ano

⏰ Tempo Integral

🟢 Júnior

🟡 Pleno

👔 Gerente

👻 Score fantasma 10%

O que significa: a chance de ninguém estar realmente contratando para esta vaga.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Por que essa pontuação:

• Aberta há 5 dias.
• As vagas desta empresa costumam ser preenchidas em 21 dias.
• Repostada uma vez.

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BlueCross BlueShield of South Carolina

SiteLinkedInTodas as Vagas

10.000+ funcionários

Fundada em 1946

🏥 Saúde

💼 Consultoria

⚖️ Jurídico

Healthcare • Consulting • Legal

Há mais de seis décadas, a BlueCross BlueShield of South Carolina faz parte do panorama nacional. Nossas raízes estão firmemente enraizadas no estado. Somos a maior companhia de seguros na Carolina do Sul. Somos também a única com uma classificação A+ Superior da A.M. Best. Somos um dos principais administradores de contratos governamentais do país. Operamos um dos centros de processamento de dados mais sofisticados do Sudeste e temos uma diversificada família de empresas subsidiárias.

Descrição

• Provide care management services to members in South Carolina and nationally • Administer complex, high-touch concierge case management for specialized programs including high-risk maternity, NICU, ESRD, Cancer, Palliative Care, and Behavioral Health • Identify risks and provide outreach to coordinate healthcare services and close care gaps • Develop individualized care plans to support cost-effectiveness, care satisfaction, and improved quality of life • Direct day-to-day high-touch member management, including program goals, treatment plans, and benefit coordination • Coordinate clinical services with providers, vendors, facilities, social workers/case managers, and community services • Educate and guide members through prior authorizations, medication adherence, and plan-of-care requirements • Participate in team training and continuing medical education • Prepare for external audits and quality assurance efforts • Manage interactions primarily by phone and messaging system on a desktop computer

🎯 Requisitos

• Associate’s degree in nursing OR graduate of an accredited school of nursing OR master’s degree in social work, Psychology, or Counseling • 5 years' case management experience as an RN OR 2 years’ case manager experience as an RN in a health insurance environment • Active, unrestricted RN licensure from the United States and in the state of hire; OR active, compact, multistate, unrestricted RN license under the Nurse Licensure Compact; OR active licensure as a social worker, psychologist, or counselor in the state of hire • Nationally recognized Case Management certification to be obtained within 2 years of hire as a Case Manager • 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 • 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 • Microsoft Office proficiency • Preferred: bachelor's degree in a health-related field • Preferred: 5 years’ experience in case management in a sub-specialty area • Preferred: working knowledge of Microsoft Word, PowerPoint, Excel, or other spreadsheet/database software; TMCS, LiveOps, MDDS, and BlueVue • Preferred: case manager certification, clinical certification in specialty area, BLS or ACLS certification

🏖️ Benefícios

• Subsidized health plans, dental and vision coverage • 401k retirement savings plan with company match • Life Insurance • Paid Time Off (PTO) • On-site cafeterias and fitness centers in major locations • Education Assistance • Service Recognition • National discounts to movies, theaters, zoos, theme parks and more • Diverse and inclusive workplace with opportunities to develop skills, advance careers and contribute to company growth • Reasonable accommodations for disabilities, pregnancy, pregnancy-related conditions, and sincerely held religious beliefs

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