Case Management Coordinator (Maternity Focus) - SC
for section headings: e.g., About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We need to decide which sections have content.
We have location (full-time remote, schedule). That's Schedule and maybe Location. We have Benefits described. We have Pay? Not mentioned. So we should not include Pay section. Schedule: we have full-time 40 hours/week Monday-Friday 8am-5pm EST, fully remote, occasional on-site. So we can put Schedule section.
About the role: we have summary paragraph about case management interventions. Could be About the role.
Responsibilities: "What You’ll Do" list.
Requirements/Qualifications: "To Qualify For This Position, You'll Need The Following" includes required education, experience, skills, software, license/certificate. Could be Requirements or Qualifications. We'll split maybe Requirements (education, experience) and Skills (skills and abilities). But we can combine into Qualifications. The instruction: prefer few substantive sections over many thin ones. So maybe we have About the role, Responsibilities, Qualifications, Benefits, Schedule. That's five sections.
We must not include headings with filler text. Ensure each heading has substantive content.
We need to use - for any list of duties/requirements/benefits. For prose use
.
We must preserve all substantive information, not invent or summarize away detail. So we need to include all details from the posting, but we can format them.
We must remove boilerplate: cookie/navigation/legal/EEO/equal-opportunity/scam-warning, duplicated lines, application instructions. So we need to cut out the Equal Employment Opportunity Statement, "What We Can Do For You", "What To Expect Next", EEO statement, etc. Also remove "Our Comprehensive Benefits Package Includes The Following" maybe keep benefits but remove fluff. Keep benefits list.
We must not include "We Prefer That You Have The Following Preferred Work Experience:" etc. That's preferred qualifications; we can include under Qualifications maybe as a subsection? But we should not invent headings like Preferred. Could include under Qualifications as a list.
We must not include license/certificate details? We need to preserve all substantive information, so include required license/certificate and preferred licenses.
We must not include "To Qualify For This Position, You'll Need The Following" as heading; we can use Qualifications heading and put content.
We must not include "Our Comprehensive Benefits Package Includes The Following" as heading; we can use Benefits heading.
We must not include "Location" as heading? Could be part of Schedule. But we have location info: fully remote in South Carolina, occasional on-site. Could be under Schedule or a separate Location section. Since we have Schedule heading, we can include location there.
We must not include Pay section because not mentioned.
Now craft HTML.
Structure:
About the role
... summary paragraph ...
Responsibilities
- ... each duty ...
...
Qualifications
Required Education: Associates in a job related field. Degree Equivalency: 2 years job related work experience.
Required Experience: 4 years recent clinical in defined specialty area. Specialty areas include: oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review/case management/clinical/or combination; 2 of the 4 years must be clinical.
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. 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.
Required Software and Tools: Microsoft Office.
Required License/Certificate: 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). For Div. 75 and Div. 6B, except for CC 426: URAC recognized Case Management Certification must be obtained within 4 years of hire as a Case Manager.
Preferred Work Experience: 4+ years of Maternity experience.
Preferred Skills and Abilities: Working knowledge of spreadsheet, database software. Thorough knowledge/understanding of claims/coding analysis, requirements, and processes.
Preferred Licenses and Certificates: Case Manager certification, clinical certification in specialty area.
Benefits
- 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
Eligibility: benefits the first of the month following 28 days of employment.
Schedule
Full-time (40 hours/week) Monday-Friday from 8:00am-5:00pm EST. Fully remote in South Carolina, with occasional on-site reporting for trainings, meetings, or other business needs.
We need to ensure we didn't include any boilerplate like EEO etc. We removed those.
Check for any duplicated lines: we have not repeated.
Check for any placeholders like "commensurate with experience" - none.
Check for any missing substantive info: The summary paragraph about case management interventions is included. The "Description Location" we placed location in schedule. The "What You’ll Do" we turned into responsibilities list. Need to ensure we captured all duties from that paragraph.
Let's extract duties from "What You’ll Do":
- 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 that consist of intensive assessment/evaluation of condition, at-risk education based on members’ identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement.
- Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans.
- 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 both health care providers and members.
- Performs medical or behavioral review/authorization process.
- Ensures coverage for appropriate services within benefit and medical necessity guidelines.
- Utilizes allocated resources to back up review determinations.
- Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.).
- Participates in data collection/input into system for clinical information flow and proper claims adjudication.
- Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal).
- Maintains current knowledge of contracts and network status of all service providers and applies appropriately.
- Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services.
We need to include all these as list items. Ensure we don't lose any.
Now check Qualifications: we included required education, experience, skills, software, license/certificate, preferred experience, preferred skills, preferred licenses. Ensure we didn't miss any: "Required Education: Associates in a job related field.Degree Equivalency: 2 years job related work experience." Good.
"Required Experience: 4 years recent clinical in defined specialty area. Specialty areas include: oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review/case management/clinical/or combination; 2 of the 4 years must be clinical." Good.
"Required Skills and Abilities:" list we included.
"Required Software and Tools: Microsoft Office." Good.
"Required License/Certificate: ..." Good.
"Preferred Work Experience: 4+ years of Maternity experience." Good.
"Preferred Skills and Abilities: Working knowledge of spreadsheet, database software.Thorough knowledge/understanding of claims/coding analysis, requirements, and processes." Good.
"Preferred Licenses and Certificates: Case Manager certification, clinical certification in specialty area." Good.
Now Benefits: we included list and eligibility sentence.
Now Schedule: we included full-time schedule and location.
Now About the role: we need to include the summary paragraph. Let's copy exactly:
"We are currently hiring for a Case Management Coordinator to join BlueCross BlueShield of South Carolina. In this role as a Case Management Coordinator, care management interventions focus on improving care coordination and reducing the fragmentation of the services the recipients of care often experience, especially when multiple health care providers and different care settings are involved. Taken collectively, care management interventions are intended to enhance client safety, well-being, and quality of life. These interventions carefully consider health care costs through the professional care manager's recommendations of cost-effective and efficient alternatives for care. Thus, effective care management directly and positively impacts the health care delivery system, especially in realizing the goals of the "Triple Aim," which include improving the health outcomes of individuals and populations, enhancing the experience of health care, and reducing the cost of care. The professional care manager performs the primary functions of assessment, planning, facilitation, coordination, monitoring, evaluation, and advocacy. Integral to these functions is collaboration and ongoing communication with the client, client's family or family caregiver, and other health care professionals involved in the client's care."
We need to ensure we didn't include job title as heading; we are not.
Now check for any leftover boilerplate: we removed EEO statement, "What We Can Do For You", "What To Expect Next", "Equal Employment Opportunity Statement", etc.
Now ensure we didn't inadvertently include any duplicated lines like "We offer our employees great benefits and rewards." We kept benefits list but maybe we should keep the sentence "We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment." We kept eligibility sentence but omitted the first sentence "We offer our employees great benefits and rewards." That's maybe fluff but could be considered substantive? It's a generic statement; maybe we can keep it as part of benefits section. The instruction: preserve ALL substantive information; do NOT invent or summarize away detail. The sentence "We offer our employees great benefits and rewards." is somewhat
. We must preserve all substantive information, not invent or summarize away detail. So we need to include all details from the posting, but we can format them. We must remove boilerplate: cookie/navigation/legal/EEO/equal-opportunity/scam-warning, duplicated lines, application instructions. So we need to cut out the Equal Employment Opportunity Statement, "What We Can Do For You", "What To Expect Next", EEO statement, etc. Also remove "Our Comprehensive Benefits Package Includes The Following" maybe keep benefits but remove fluff. Keep benefits list. We must not include "We Prefer That You Have The Following Preferred Work Experience:" etc. That's preferred qualifications; we can include under Qualifications maybe as a subsection? But we should not invent headings like Preferred. Could include under Qualifications as a list. We must not include license/certificate details? We need to preserve all substantive information, so include required license/certificate and preferred licenses. We must not include "To Qualify For This Position, You'll Need The Following" as heading; we can use Qualifications heading and put content. We must not include "Our Comprehensive Benefits Package Includes The Following" as heading; we can use Benefits heading. We must not include "Location" as heading? Could be part of Schedule. But we have location info: fully remote in South Carolina, occasional on-site. Could be under Schedule or a separate Location section. Since we have Schedule heading, we can include location there. We must not include Pay section because not mentioned. Now craft HTML. Structure:
About the role
... summary paragraph ...
Responsibilities
- ... each duty ... ...
Qualifications
Required Education: Associates in a job related field. Degree Equivalency: 2 years job related work experience.
Required Experience: 4 years recent clinical in defined specialty area. Specialty areas include: oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review/case management/clinical/or combination; 2 of the 4 years must be clinical.
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. 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.
Required Software and Tools: Microsoft Office.
Required License/Certificate: 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). For Div. 75 and Div. 6B, except for CC 426: URAC recognized Case Management Certification must be obtained within 4 years of hire as a Case Manager.
Preferred Work Experience: 4+ years of Maternity experience.
Preferred Skills and Abilities: Working knowledge of spreadsheet, database software. Thorough knowledge/understanding of claims/coding analysis, requirements, and processes.
Preferred Licenses and Certificates: Case Manager certification, clinical certification in specialty area.
Benefits
- 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
Eligibility: benefits the first of the month following 28 days of employment.
Schedule
Full-time (40 hours/week) Monday-Friday from 8:00am-5:00pm EST. Fully remote in South Carolina, with occasional on-site reporting for trainings, meetings, or other business needs.
We need to ensure we didn't include any boilerplate like EEO etc. We removed those. Check for any duplicated lines: we have not repeated. Check for any placeholders like "commensurate with experience" - none. Check for any missing substantive info: The summary paragraph about case management interventions is included. The "Description Location" we placed location in schedule. The "What You’ll Do" we turned into responsibilities list. Need to ensure we captured all duties from that paragraph. Let's extract duties from "What You’ll Do": - 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 that consist of intensive assessment/evaluation of condition, at-risk education based on members’ identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement. - Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans. - 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 both health care providers and members. - Performs medical or behavioral review/authorization process. - Ensures coverage for appropriate services within benefit and medical necessity guidelines. - Utilizes allocated resources to back up review determinations. - Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.). - Participates in data collection/input into system for clinical information flow and proper claims adjudication. - Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal). - Maintains current knowledge of contracts and network status of all service providers and applies appropriately. - Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services. We need to include all these as list items. Ensure we don't lose any. Now check Qualifications: we included required education, experience, skills, software, license/certificate, preferred experience, preferred skills, preferred licenses. Ensure we didn't miss any: "Required Education: Associates in a job related field.Degree Equivalency: 2 years job related work experience." Good. "Required Experience: 4 years recent clinical in defined specialty area. Specialty areas include: oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review/case management/clinical/or combination; 2 of the 4 years must be clinical." Good. "Required Skills and Abilities:" list we included. "Required Software and Tools: Microsoft Office." Good. "Required License/Certificate: ..." Good. "Preferred Work Experience: 4+ years of Maternity experience." Good. "Preferred Skills and Abilities: Working knowledge of spreadsheet, database software.Thorough knowledge/understanding of claims/coding analysis, requirements, and processes." Good. "Preferred Licenses and Certificates: Case Manager certification, clinical certification in specialty area." Good. Now Benefits: we included list and eligibility sentence. Now Schedule: we included full-time schedule and location. Now About the role: we need to include the summary paragraph. Let's copy exactly: "We are currently hiring for a Case Management Coordinator to join BlueCross BlueShield of South Carolina. In this role as a Case Management Coordinator, care management interventions focus on improving care coordination and reducing the fragmentation of the services the recipients of care often experience, especially when multiple health care providers and different care settings are involved. Taken collectively, care management interventions are intended to enhance client safety, well-being, and quality of life. These interventions carefully consider health care costs through the professional care manager's recommendations of cost-effective and efficient alternatives for care. Thus, effective care management directly and positively impacts the health care delivery system, especially in realizing the goals of the "Triple Aim," which include improving the health outcomes of individuals and populations, enhancing the experience of health care, and reducing the cost of care. The professional care manager performs the primary functions of assessment, planning, facilitation, coordination, monitoring, evaluation, and advocacy. Integral to these functions is collaboration and ongoing communication with the client, client's family or family caregiver, and other health care professionals involved in the client's care." We need to ensure we didn't include job title as heading; we are not. Now check for any leftover boilerplate: we removed EEO statement, "What We Can Do For You", "What To Expect Next", "Equal Employment Opportunity Statement", etc. Now ensure we didn't inadvertently include any duplicated lines like "We offer our employees great benefits and rewards." We kept benefits list but maybe we should keep the sentence "We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment." We kept eligibility sentence but omitted the first sentence "We offer our employees great benefits and rewards." That's maybe fluff but could be considered substantive? It's a generic statement; maybe we can keep it as part of benefits section. The instruction: preserve ALL substantive information; do NOT invent or summarize away detail. The sentence "We offer our employees great benefits and rewards." is somewhat