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. To work from home you must have high-speed (non-satellite) internet and a private secure home office.

• Attach a copy of your current RN license report to your application or Include your RN license number on your resume

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.

Location

This position is full-time (40 hours/week) Monday-Friday from 8:00am-4:30pm EST or 8:30am-5:00pm EST and will be fully remote.

To work from home you must have high-speed (non-satellite) internet and a private secure home office.

What Youll Do:

• Directs 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.
  
• Coordinates clinical services with external sources to include: providers vendors facilities social workers/case managers and/or community services.
  
• Participates in team training and continuing medical education.
  
• Prepares for external audits and quality assurance efforts.
  

To Qualify for This Position Youll Need the Following:

Required Education: Associates degree in nursing OR Graduate of Accredited School of Nursing OR masters 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.

We Prefer That You Have the Following:

Preferred Education: Bachelors degree in health-related field (Nursing Healthcare Administration Pharmacy Sciences Applied Health)

Preferred Work Experience: 5 years experience in case management in a sub-specialty area (i.e. ICU Palliative Care Hospice or Home Health Behavioral health and Case Management.)

Preferred Skills and Abilities:

• Strong communication and customer services skills
• Excellent analytical skills to problem solve and remedy issues immediately
• Ability to work in an autonomous environment or leadership capacity

Preferred Software and Tools: Working knowledge of Microsoft Word PowerPoint Excel or other spreadsheet/database software; TMCS LiveOps MDDS and BlueVue.

Preferred Licenses and Certificates: Case manager certification clinical certification in specialty area. Basic Life Support (BLS) or Advanced Cardiac Life Support (ACLS) certification.

Our Comprehensive Benefits Package Includes the Following:

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits for the first of the month following 28 days of employment.

• 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

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills advance their careers and contribute their unique abilities to the growth of our company.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age race color national origin sex religion veteran status disability weight sexual orientation gender identity genetic information or any other legally protected status. Additionally as a federal contractor the company maintains affirmative action programs to promote employment opportunities for individuals with disabilitiesand protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities pregnant individuals individuals with pregnancy-related conditions and individuals needing accommodations for sincerely held religious beliefs provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment please email or call ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Heres moreinformation.

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