RN Concierge Care Manager – Maternity/NICU

🕒 2 days ago

🌴 South Carolina – Remote

🌴 South Carolina – Remote

💵 $57.8k - $110.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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BlueCross BlueShield of South Carolina

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1946

🏥 Healthcare

💼 Consulting

⚖️ Legal

Healthcare • Consulting • Legal

BlueCross BlueShield of South Carolina is a leading health insurance provider that offers a variety of health plans, including individual and family plans, Medicare options, and group health plans. The organization focuses on providing coverage and resources for members, employers, and healthcare providers, ensuring access to quality healthcare services. With a commitment to promoting healthier lifestyles and supporting community health, BlueCross BlueShield of South Carolina plays a vital role in the healthcare landscape of the region.

📋 Description

• Provide care management services to over 2 million members • 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 provide outreach services to facilitate the coordination of healthcare services and gap closure • Provide individualized care plans to ensure cost-effectiveness, overall care satisfaction, and improved quality of life. • Direct day-to-day, high-touch member management including implementation of program goals, coordination of treatment plans and benefit coordination for high-risk patient populations • Coordinates clinical services with external sources including: 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.

🎯 Requirements

• Associate’s degree in nursing OR Graduate of Accredited School of Nursing OR master’s degree in social work, Psychology, or Counseling • 5 years' case management experience or 2 years’ case manager experience in a health insurance environment • 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. • 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.

🏖️ Benefits

• 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