Case Management Coordinator – Renal/Nephrology

BlueCross BlueShield of South Carolina

Care Management Coordinator at BlueCross BlueShield of South Carolina improving care coordination for patients. Responsible for assessment, planning, monitoring, and patient advocacy in remote settings.

Posted 6/25/2026full-timeRemote • South Carolina • 🇺🇸 United StatesMid-LevelSeniorWebsite

About the role

Key responsibilities & impact

Provides active care management, assessing service needs, developing and coordinating action plans in cooperation with members, monitoring services and implementing plans, including member goals
Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions
Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits
Provides telephonic support for members with chronic conditions, high-risk pregnancy, or other at-risk conditions, including intensive assessment/evaluation
Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans
Ensures coverage for appropriate services within benefit and medical necessity guidelines
Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, etc.)
Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies

Requirements

What you’ll need

Associate's in a job related field
4 years recent clinical experience in defined specialty area, which may include oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, general medicine/surgery
4 years utilization review/case management/clinical or combination; 2 of the 4 years must be clinical
Working knowledge of word processing software
Knowledge of quality improvement processes
Knowledge of contract language and application
Good judgment skills
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 critical thinking skills
Ability to handle confidential or sensitive information with discretion
An active, unrestricted RN license from the United States
URAC recognized Case Management Certification must be obtained within 4 years of hire as a Case Manager for certain licenses

Benefits

Comp & perks

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

clinical experienceutilization reviewcase managementtelephonic supportpatient educationquality improvement processescontract languagedocumentation of clinical informationassessment/evaluationmedical necessity criteria

Soft Skills

good judgmentcustomer serviceorganizational skillspresentation skillsoral communicationwritten communicationpersuasionnegotiationanalytical skillsdiscretion

Certifications

active RN licenseURAC Case Management Certification