[Hiring] Medical Case Manager @BlueCross BlueShield of Tennessee

Role Description

SelectCommunity at BCBST is seeking a Registered Nurse Case Manager who is compassionate about case management, advocating for social, emotional, functional, mental, behavioral, and physical health of those who are intellectually and developmentally disabled.

In this role, the SelectCommunity Nurse Care Manager (NCM) assesses members’ current status, facilitates coordination of long-term services and supports under their insurance benefits and benefits under Department of Disability and Aging. The SelectCommunity NCM collaborates with members, caregivers, conservators, and providers to develop individual, integrated plans of care based on health needs, while monitoring progress for members with multiple levels of acuity.

This role requires telephonic contacts and in-person home visits with members on at least a monthly basis and as required by TennCare Contract.

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.

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 - 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.
• Excellent oral and written communication skills.
• PC Skills required (Basic Microsoft Office and E-Mail).

Requirements

• 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).

Number of Openings Available

• 1

Worker Type

• Employee