RN Behavioral Health Concierge Care Manager

🕒 August 17

🌴 South Carolina – Remote

🌴 South Carolina – Remote

💵 $57.8k - $110.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 37%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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 provide outreach services to coordinate healthcare services and close care gaps • Provide individualized care plans to ensure cost-effectiveness, care satisfaction, and improved quality of life • Direct day-to-day high-touch member management, including implementation of program goals, treatment-plan coordination, and benefit coordination • Coordinate clinical services with providers, vendors, facilities, social workers/case managers, and community services • Educate and guide members through prior authorizations, medication adherence, and plan-of-care requirements • Conduct highly interactive case management primarily 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 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 • Microsoft Office proficiency • 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 • High-speed (non-satellite) internet and a private, secure home office • Preferred: Bachelor's degree in a health-related field • Preferred: Previous experience in an Autism specialty or working with autistic patients • Preferred: 5 years’ experience in case management in a sub-specialty area • Preferred: Working knowledge of Microsoft Word, PowerPoint, Excel, or other spreadsheet/database software; TMCS, LiveOps, MDDS, and BlueVue • Preferred: Case manager certification, clinical certification in specialty area, BLS or ACLS certification

🏖️ 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 • Reasonable accommodations for disabilities, pregnancy-related conditions, and sincerely held religious beliefs