RN Medical Case Manager

🔥 19 minutes ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

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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

• Provide comprehensive, member-centered care for individuals with complex and chronic conditions, including high-risk diagnoses • Use a proactive, advocacy-driven approach to support members • Collaborate across multidisciplinary teams to coordinate care, reduce barriers, and improve health outcomes • Support cost-effective utilization of services and reduce unnecessary ED and inpatient utilization • Manage a dynamic caseload • Support utilization management functions for more complex and non-routine cases as needed • Serve as a liaison between members, providers, and internal/external customers in coordinating healthcare 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, coordinating, monitoring, outcomes, and evaluation • Communicate via digital channels and offer technical support

🎯 Requirements

• 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 • 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 • Excellent oral and written communication skills • PC skills required (Basic Microsoft Office and E-Mail) • Strong technical proficiency • Ability to effectively communicate via digital channels and offer technical support • Ability to assess and manage complex needs in a telephonic and digital environment • Ability to navigate care across the continuum • Ability to effectively engage members to drive adherence and outcomes • Willingness to leverage enterprise-approved digital and AI tools • Digital literacy assessment required • Various immunizations and/or associated medical tests may be required

🏖️ Benefits

• Employee position • Various immunizations and/or associated medical tests may be required for this position