Complex Case Manager

🔥 0 minutes ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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BlueCross BlueShield of Tennessee

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1952

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

BlueCross BlueShield of Tennessee is a leading health plan provider in Tennessee, serving 3. 4 million members. The company is committed to creating a workforce where everyone is valued, respected, and part of the team, emphasizing diversity and inclusion. They offer a range of career opportunities, including internships through their BlueBridge program, enabling new professionals to transition from college to work. BlueCross BlueShield of Tennessee also focuses on providing exceptional customer service and community care, striving to make a difference in the healthcare industry. It is an independent licensee of the Blue Cross Blue Shield Association and a qualified health plan issuer in the Health Insurance Marketplace.

📋 Description

• Support utilization management functions for complex and non-routine cases as needed • Serve as a liaison between members, providers, and internal/external customers in coordinating health care delivery and benefits programs • Oversee highly complex cases to ensure effective implementation of interventions and efficient utilization of benefits • Perform case management activities including assessment, planning, implementation, coordination, monitoring, outcomes, and evaluation • Manage complex members telephonically and digitally with significant medical and psychosocial needs • Provide health teaching and ensure timely, effective interventions and follow-up • Apply clinical judgment to identify interventions and leverage multidisciplinary resources and referrals • Communicate effectively through digital channels and offer technical support

🎯 Requirements

• Registered Nurse (RN) with an active license in Tennessee, or a license in the state of residence if participating in the Nurse Licensure Compact • 3 years of clinical experience required • 5 years of experience in the health care industry • For Select Community, 2 years of experience in IDD is required • Excellent oral and written communication skills • Basic Microsoft Office and email skills • Strong digital literacy and technical proficiency • Ability to communicate effectively via digital and telephonic channels • Ability to manage high volumes of work while maintaining attention to detail • Ability to balance competing priorities and remain accountable for results • Must complete a digital literacy assessment • Sponsorship is not available • Certain immunizations and/or associated medical tests may be required • Employees routinely operating a company, personal, or rental vehicle must maintain a valid driver’s license, comply with auto insurance requirements, and maintain an acceptable motor vehicle record

🏖️ Benefits

• Remote work • Remote-first organization • Working hours of Monday–Friday, 8:00 a.m.–5:00 p.m. eastern time or depending on time zone • Opportunity to leverage enterprise-approved AI tools to enhance care delivery and workflow efficiency • Relocation assistance may be available if the position requires residence in Chattanooga, TN