Behavioral Health Case Manager II

🔥 4 hours ago

🌴 South Carolina – Remote

🌴 South Carolina – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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BlueCross BlueShield of South Carolina

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1946

⚕️ Healthcare Insurance

💸 Finance

Healthcare Insurance • Insurance • Finance

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

• Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria • Applies clinical expertise and Administrative policies to service requests • Provides health management program interventions • Assesses, plans, implements, coordinates, monitors, and evaluates medical necessity options and services • Promotes quality, cost effective outcomes • Provides telephonic support for members with chronic conditions or high-risk pregnancy • Conducts intensive assessment/evaluation and at-risk education • Engages members through motivational interviewing and reflective listening • Identifies and participates in on-site reviews • Serves as member advocate through communication and education • Promotes enrollment in care management programs • Ensures accurate documentation of clinical information • Participates in data collection/input into system for clinical information flow

🎯 Requirements

• Associate's in a job related field • 4 years recent clinical in defined specialty area (oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, general medicine/surgery) • 4 years utilization review/case management/clinical/or combination; 2 of the 4 years must be clinical • 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 • Good judgment skills • 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 critical thinking skills • Ability to handle confidential or sensitive information with discretion • An active, unrestricted RN license 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, unrestricted licensure as social worker from the United States and in the state of hire (in Div. 6B) or active, unrestricted licensure as counselor, or psychologist from the United States and in the state of hire (in Div. 75 only)

🏖️ Benefits

• Subsidized health plans • Dental and vision coverage • 401 k 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