Concierge Care Manager

Internal Reference Number: R1043329

Summary We 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 medical case management. Identify risks and provide outreach services to facilitate the coordination of healthcare services and gap closure. Provides individualized care plans to ensure improved quality of life, cost-effectiveness, and overall care satisfaction.

The position will be working from home on a desktop computer to provide highly interactive case management to assigned members. Members will include those with chronic or high-risk conditions and those who are admitted to inpatient care. Educating and guiding members through prior authorizations and understanding the need to adhere to medications and the plan of care. Most interactions will be by phone and through our messaging system. Perfect for those who love case management and improving the lives and medical outcomes of members while working in your own home office.

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 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!

Having over 15,000 employees across the country opens a lot of career opportunities. You can move up within your line of business or move to another one of our lines of business. You retain your tenure and benefits while growing your career in a different area. This is not possible at most smaller organizations. We also offer a generous education reimbursement program to prepare you for future career growth.

Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.Description

Logistics: About Us | BlueCross BlueShield of South Carolina

Location: This position is full time (40 hours/week) Monday-Friday and will be fully remote (Work at Home). To work from home, you must have high-speed (non-satellite) internet and a private, secure home office.

What You'll Do:

Direct 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.

Coordinate clinical services with external sources, including providers, vendors, facilities, social workers/case managers, and/or community services.

Participate in team training and continuing medical education.

Prepare for external audits and quality assurance efforts.

To Qualify for This Position, You'll Need the Following:

Required Education: Associate's degree in nursing; OR Graduate of Accredited School of Nursing. For Div 75 and 6B requires Master's degree in Social Work, Psychology, or Counseling.

Degree Equivalency: Degree Equivalency not applicable for the Celerian Group, Bachelor's degree required.

5 years' case management experience as a RN or 2 years' case manager experience as a RN in a health insurance environment.

Required Skills and Abilities: 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. Demons