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Behavioral Health Case Manager II
BlueCross BlueShield of South CarolinaBehavioral Health Case Manager II providing health management program interventions. Evaluating medical or behavioral eligibility and supporting members in managing their health.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in clinical assessment, care management, and utilization review, with a strong focus on quality improvement and member advocacy. Proficient in motivational interviewing and effective communication to support members with chronic conditions and high-risk pregnancies.
Highest-signal resume keywords
Active RN LicenseUtilization ReviewCase ManagementClinical AssessmentQuality Improvement
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical EvaluationHealth Management Program InterventionsData CollectionMedical Necessity AssessmentDocumentation Accuracy
Soft Skills
Motivational InterviewingOrganizational SkillsPresentation SkillsAnalytical ThinkingDecision-Making
Tools & Technologies
Word Processing Software
Certifications & Qualifications
Active RN LicenseSocial Worker LicenseCounselor LicensePsychologist License
Industry Keywords
Chronic ConditionsHigh-Risk PregnancyMember AdvocacyOn-Site ReviewsConfidential Information Handling
About the role
Key responsibilities & impact- Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria
- Applies clinical expertise and Administrative policies to service requests
- Provides health management program interventions
- Assesses, plans, implements, coordinates, monitors, and evaluates medical necessity options and services
- Promotes quality, cost effective outcomes
- Provides telephonic support for members with chronic conditions or high-risk pregnancy
- Conducts intensive assessment/evaluation and at-risk education
- Engages members through motivational interviewing and reflective listening
- Identifies and participates in on-site reviews
- Serves as member advocate through communication and education
- Promotes enrollment in care management programs
- Ensures accurate documentation of clinical information
- Participates in data collection/input into system for clinical information flow
Requirements
What you’ll need- Associate's in a job related field
- 4 years recent clinical in defined specialty area (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 and demonstrated ability with these activities
- 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 as defined by the Nurse Licensure Compact (NLC) or active, unrestricted licensure as social worker from the United States and in the state of hire (in Div. 6B) or active, unrestricted licensure as counselor, or psychologist from the United States and in the state of hire (in Div. 75 only)
Benefits
Comp & perks- Subsidized health plans
- Dental and vision coverage
- 401 k 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