Concierge Care Manager - BlueCross BlueShield of South Carolina : Job Details

SummaryWe are currently hiring for a Concierge Care Manager to join BlueCross BlueShield of South Carolina. In this role as Concierge Care Manager, you will provide care management services to more than 2 million members in South Carolina and nationally. You will administer complex, high-touch concierge case management for members identified into specialized programs such as high-risk maternity, NICU, ESRD, and Palliative Care Behavioral Health. You will also identify risks and provide 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.Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we've been part of the national landscape, 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 nation's 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 that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.DescriptionLogistics: This position is full time (40 hours/week) Monday-Friday and will be fully remote (W@H).What You Will 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, including 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, You Will Need:

• Associate's degree in Nursing; OR Graduate of Accredited School of Nursing; OR Master's degree in Social Work, Psychology, OR Counseling (Div. 75 and 6B only).
• Five years' case management experience as a RN OR two years' case manager experience as a RN in a health insurance environment.
• 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.
• Microsoft Office.
• 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 will be obtained within two years of hiring as a case manager.

What We Prefer:

• Bachelor's degree in a health-related field (Nursing, Healthcare Administration, Pharmacy, Sciences, Applied Health).
• Five years experience in case management in a sub-specialty area (i.e., ICU, Palliative Care, Hospice, OR Home Health).
• Strong communication and customer service skills.
• Excellent analytical skills to problem-solve and remedy issues immediately.
• Ability to work in an autonomous environment OR leadership capacity.
• Working knowledge of Microsoft Word, PowerPoint, Excel, OR other spreadsheet/database software; TMCS, LiveOps, MDDS, and BlueVue.
• Case manager certification, clinical certification in a specialty area.
• Basic Life Support (BLS) OR Advanced Cardiac Life Support (ACLS) certification.

What We Can Do for You:

• 401(k) retirement savings plan with company match.
• Subsidized health plans and free vision coverage.
• Life insurance.
• Paid annual leave - the longer you work here, the more you earn.
• Nine paid holidays.
• On-site cafeterias and fitness centers in major locations.
• Wellness programs and healthy lifestyle premium discount.
• Tuition assistance.
• Service recognition.
• Incentive Plan.
• Merit Plan.
• Continuing education funds for additional certifications and certification renewal.

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 a recruiter to verify resume specifics and salary requirements.Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Some states have required notifications. Here's more information. Equal Employment Opportunity StatementBlueCross 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 minorities, females, disabled individuals and 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 physical and mental disabilities.If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-###-####, 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.