RN Case Management Coordinator

BlueCross BlueShield of South Carolina

Case Management Coordinator improving care coordination and managing member health services at BlueCross BlueShield of South Carolina. Ensuring effective care management and collaboration with healthcare providers in South Carolina.

Posted 6/27/2026full-timeRemote • South Carolina • 🇺🇸 United StatesMid-LevelSeniorWebsite

About the role

Key responsibilities & impact

Provides active care management, assesses service needs, develops and coordinates action plans in cooperation with members
Monitors services and implements plans, to include 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
Participates in direct intervention/patient education with members and providers regarding health care delivery system
May identify, initiate, and participate in on-site reviews
Serves as member advocate through continued communication and education
Promotes enrollment in care management programs and/or health and disease management programs
Provides appropriate communications (written, telephone) regarding requested services to health care providers and members
Performs medical or behavioral review/authorization process
Ensures coverage for appropriate services within benefit and medical necessity guidelines
Identifies and makes referrals to appropriate staff

Requirements

What you’ll need

Associates in a job-related field
4 years recent clinical in defined specialty area or 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
Ability to work independently, prioritize effectively, and make sound decisions
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 and in the state of hire OR active compact multistate unrestricted RN license OR active, unrestricted licensure as social worker OR active, unrestricted licensure as counselor, or psychologist

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

✓ Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

clinical assessmentcare managementutilization reviewcase managementmedical necessity criteriapatient educationquality improvement processesdocumentationanalytical skillsconfidential information handling

Soft Skills

independent workprioritizationdecision makinggood judgmentcustomer serviceorganizational skillspresentation skillsoral communicationwritten communicationpersuasion

Certifications

RN licensesocial worker licensecounselor licensepsychologist license