Case Manager

Job Description

Join our team as an RN Case Manager, a vital member of our Population Health team, working fully remote and embedded within an interdisciplinary team. Our ideal candidate will engage with members through telephonic outreach, utilizing critical thinking for assessment, planning, and implementation. You will find fulfillment in supporting our members with personalized care coordination, empowering them with tools, education, and self-care coaching to achieve long-term lifestyle changes.

This role is designed to improve member outcomes, be cost-effective, and promote positive operational results. We seek a dedicated, caring, and compassionate individual who is organized, has excellent communication skills, and is proficient with technology. Notes:
The RN should hold a compact license. CCM certification is not required but is preferred. Business hours are 8-6 EST, with leadership working with each case manager to establish a schedule within these hours, allowing for adjustments to meet member needs. A commitment to leveraging AI-enabled tools and technology to improve efficiency, streamline processes, and support continuous operational improvement.

• Supporting utilization management functions for more complex and non-routine cases as needed.
• Serving as a liaison between members, providers and internal/external customers in coordination of health care delivery and benefits programs.
• Overseeing highly complex cases identified through various mechanisms to ensure effective implementation of interventions, and to ensure efficient utilization of benefits.
• Performing the essential activities of case management: assessment, planning, implementation, coordinating, monitoring, outcomes and evaluation.
• Digital positions must have the ability to effectively communicate via digital channels and offer technical support.
• Effective 7/22/13:
  This Position requires an 18 month commitment before posting for other internal positions.
• Various immunizations and/or associated medical tests may be required for this position.
• This job requires digital literacy assessment.

• License 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.
• Experience 3 years
  - Clinical experience required.
• Experience 5 years
  - Experience in the health care industry.
• For Select Community and Katie Beckett: 2 years experience in IDD for Select Community is required.
• Skills/
  
  Certifications:
  
  Excellent oral and written communication skills.
• PC Skills required (Basic Microsoft Office and E-Mail).
• Employees who are required to operate either a BCBST-owned vehicle or a personal or rental vehicle for company business on a routine basis will be automatically enrolled into the BCBST Driver Safety Program. The employee will also be required to adhere to the guidelines set forth through the program. This includes maintaining a valid driver’s license, auto insurance compliance with minimum liability requirements;
  
  as defined in the “Use of Non BCBST-Owned Vehicle” Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR). The definition for “routine basis” is defined as daily, weekly or at regularly schedule times.

• Number of Openings Available: 1
• Worker Type:
  Employee
• Company: BCBST Blue Cross Blue Shield of Tennessee, Inc.

BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law. Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page: BCBST's EEO Policies/Notices.

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