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 promotes 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.
Job Responsibilities
- 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.
Job Qualifications
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
- 5 years - Experience in the health care industry
- For Select Community & 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)
Number of Openings Available
1Worker Type:
EmployeeCompany:
BCBST BlueCross BlueShield of Tennessee, Inc.Applying for this job indicates your acknowledgement and understanding of the following statements:
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
BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.
Skills Required
- Registered Nurse (RN) with active license in Tennessee or license in a Nurse Licensure Compact state
- Compact nursing license (Nurse Licensure Compact) or eligibility
- 3 years clinical experience
- 5 years experience in the health care industry
- 2 years experience in IDD for Select Community & Katie Beckett (when applicable)
- Excellent oral and written communication skills
- Basic PC skills including Microsoft Office and email
- Digital literacy assessment (must pass)
- Commitment to leveraging AI-enabled tools and technology
- Ability to effectively communicate via digital channels and provide basic technical support
- CCM (Certified Case Manager) certification
- 18-month commitment to role before applying for other internal positions
- Various immunizations and/or associated medical tests may be required
What We Do
As Tennessee's largest health plan, we've been helping Tennesseans find their own unique paths to good health for more than 70 years. More than that, we're your neighbors and friends – fellow Tennesseans with deep roots of caring tradition, a focused approach to physical, financial and community good health for today, and a bright outlook for an even healthier tomorrow. Our mission is simple: peace of mind through better health. We're an independent, not-for-profit, locally governed health plan company – meaning we live and work alongside our Tennessee business customers and plan members. Our 6,000 employees across the state have built our strong reputation for integrity, excellent service and community leadership. But we are also part of the BlueCross BlueShield Association, a nationwide association of health care plans. Because of this, our plan members have access to the same quality health benefits while traveling or living out of state that they have while in Tennessee. © 2018 BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association.
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