RN Concierge Care Manager - Case Management

Internal Reference Number: R1047657

We are currently hiring for an RN Concierge Care Manager - Case Management to join Blue Cross Blue Shield of South Carolina. In this role as an RN Concierge Care Manager - Case Management, you will provide care management services to more than 2 million members in South Carolina and nationally, administer complex, high‑touch concierge case management for members identified into specialized programs such as high‑risk maternity, NICU, ESRD, Cancer, Palliative Care or Behavioral Health, identify risks and provide outreach services to facilitate the coordination of healthcare services and gap closure, and provide individualized care plans to ensure cost‑effectiveness, overall care satisfaction, and improved quality of life.

The position will be fully remote on a desktop computer to provide highly interactive case management to assigned members. Members will include those with chronic or high‑risk conditions and those who are admitted to inpatient care. You will educate and guide members through prior authorizations and understanding the need to adhere to medications and the plan of care. Most interactions will be by phone and through our messaging system, perfect for those who love case management and improving the lives and medical outcomes of members while working in your own home office.

Candidates who live within 50 miles of the Columbia office (4101 Percival Rd Ste 120, Columbia, SC 29229) and reside in South Carolina will be required to come on‑site for one day of orientation to receive their equipment. After orientation, the position will be fully remote. This requirement does not apply to candidates residing in other states.

This position is full‑time (40 hours/week) Monday‑Friday from 8:00 am‑4:30 pm EST or 8:30 am‑5:00 pm EST and will be fully remote. To work from home, you must have high‑speed (non‑satellite) internet and a private, secure home office.

• Direct day‑to‑day, high‑touch member management to include implementation of program goals, coordination of treatment plans and benefit coordination for high‑risk patient populations and/or those with complex conditions.
• Coordinate clinical services with external sources to include providers, vendors, facilities, social workers/case managers and/or community services.
• Participate in team training and continuing medical education.
• Prepare for external audits and quality assurance efforts.

• Required
  
  Education:
  
  Associate’s degree in nursing OR Graduate of Accredited School of Nursing OR master’s degree in social work, Psychology, or Counseling (Div. 75 and 6B) only.
• Required
  
  Work Experience:
  
  5 years’ case management experience as an RN OR 2 years’ case manager experience as an RN in a health insurance environment.
• Required
  
  Skills and Abilities:
  
  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.
• Required Software and Tools: Microsoft Office.
• Required Licenses and Certificates: 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 (Div. 75 only). Nationally recognized Case Management certification to be obtained within 2 years of hire as a Case Manager.

• Preferred Education: Bachelor’s degree in health‑related field (Nursing, Healthcare Administration, Pharmacy, Sciences, Applied Health).
• Preferred
  
  Work Experience:
  
  5 years’ experience in case…