Women's Healthcare Case Manager
BlueCross BlueShield of Tennessee
full-time
Posted on:
Location Type: Remote
Location: Remote • Tennessee • 🇺🇸 United States
Visit company websiteJob Level
Mid-LevelSenior
About the role
- Assess member needs and create individualized care plans.
- Educate and support members through some of life’s most complex transitions.
- Coordinate care with OB/GYNs, PCPs, and behavioral health specialists
- Monitor progress, adjust plans, and advocate for access and adherence.
- 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.
Requirements
- License 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
- Currently has a Certified Case Manager (CCM) credential or must obtain certification within 2 years of hire.
- For Select Community & Katie Beckett: In addition to CCM, Certification in Developmental Disabilities Nursing (CDDN) is required at hire, or must be attained within 3 years.
- Excellent oral and written communication skills
- PC Skills required (Basic Microsoft Office and E-Mail)
Benefits
- Various immunizations and/or associated medical tests may be required for this position.
- Effective 7/22/13: This Position requires an 18 month commitment before posting for other internal positions.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
case managementcare planningutilization managementclinical experiencemonitoringadvocacyimplementationevaluation
Soft skills
communicationcoordinationsupporteducationliaison
Certifications
Registered Nurse (RN)Certified Case Manager (CCM)Certification in Developmental Disabilities Nursing (CDDN)