Why should you join the BlueCross BlueShield of South Carolina family of companies Other companies come and go but weve been part of the national landscape for more than seven decades with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina and much more. We are one of the nations leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy consider joining our team!

Position Purpose:

Provides care management services to more than 2 million members in South Carolina and nationally. Administers 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. Identifies risks and provides outreach services to facilitate the coordination of healthcare services and gap closure. Provides individualized care plans to ensure cost-effectiveness overall care satisfaction and improved quality of life.

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 a RN or 2 years case manager experience as a 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 Degree Equivalency:
• Preferred Work Experience: 5 years experience in case management in a sub-specialty area (i.e. ICU Palliative Care Hospice or Home Health)
• 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 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 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.

What To Expect Next:

After submitting your application our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements

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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