RN Behavioral Health Concierge Care Manager

🔥 0 minutes ago

🌴 South Carolina – Remote

🌴 South Carolina – Remote

💵 $57.8k - $110.4k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 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 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 conduct outreach to coordinate healthcare services and close care gaps • Create individualized care plans focused on cost-effectiveness, care satisfaction, and quality of life • Direct day-to-day high-touch member management and implement program goals • Coordinate treatment plans and benefits for high-risk and complex-condition populations • Coordinate clinical services with providers, vendors, facilities, social workers/case managers, and community services • Educate and guide members through prior authorizations, medication adherence, and care plans • Conduct most interactions by phone and messaging system • Participate in team training and continuing medical education • Prepare for external audits and quality assurance efforts

🎯 Requirements

• 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 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, presentation, spelling, punctuation, grammar, oral communication, 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 • Proficiency with Microsoft Office • 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 • Preferred bachelor’s degree in a health-related field • Preferred experience in an Autism specialty or working with autistic patients • Preferred 5 years’ case management experience in a sub-specialty area such as ICU, Palliative Care, Hospice, or Home Health • Preferred case manager certification or clinical certification in a specialty area • Preferred Basic Life Support (BLS) or Advanced Cardiac Life Support (ACLS) certification • High-speed, non-satellite internet • Private, secure home office • Availability Monday-Friday, 8:00am-5:00pm EST • Current RN license copy or RN license number on resume requested

🏖️ 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 • Diverse and inclusive workplace • Opportunities to develop skills and advance careers • Reasonable accommodations for disabilities, pregnancy-related conditions, and sincerely held religious beliefs