[Hiring] Complex Medical Case Manager @BlueCross BlueShield of Tennessee

Role Description

We are seeking a dedicated and experienced Case Manager to join our team. This motivated nurse will be responsible for managing complex members telephonically/digitally with significant medical and psychosocial needs who require health teaching and to ensure timely, effective interventions and efficient use of benefits.

• Apply sound clinical judgment to identify appropriate interventions.
• Leverage multidisciplinary resources and referrals.
• Provide consistent follow-up to achieve optimal outcomes.
• Manage high volumes of work while maintaining exceptional attention to detail.
• Balance competing priorities, sustain momentum, and remain accountable for results over time.
• Utilize strong digital and telephonic communication skills.
• Demonstrate solid technical proficiency and high digital literacy.
• Leverage enterprise-approved AI tools to enhance care delivery and improve workflow efficiency.

A clinical background in managing complex cases, with experience in areas such as Med-Surg, ICU, Home Health, and/or Hospice is strongly preferred.

Note: This is a remote role with working hours of Monday–Friday (8:00 a.m.–5:00 p.m.) eastern time or depending on time zone. Sponsorship is not available for this role.

Qualifications

• 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.
• 3 years of clinical experience required.
• 5 years of experience in the health care industry.
• For Select Community & Katie Beckett: 2 years experience in IDD for Select Community is required.
• Excellent oral and written communication skills.
• PC Skills required (Basic Microsoft Office and E-Mail).

Requirements

• 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 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.
• 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 a digital literacy assessment.

Benefits

• 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, including maintaining a valid driver’s license, auto insurance compliance with minimum liability requirements, and maintaining an acceptable motor vehicle record (MVR).

Company Description

BCBST BlueCross BlueShield of Tennessee, Inc. is committed to recruiting, hiring, training, and promoting 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.