Concierge Care Manager

About the role

Provides care management services to more than 2 million members in South Carolina and nationally. Administers complex, high-touch concierge case management for members identified into specialized programs such as high-risk maternity, NICU, ESRD, Cancer, Palliative Care or Behavioral Health. Identifies risks and provides outreach services to facilitate the coordination of healthcare services and gap closure. Provides individualized care plans to ensure cost-effectiveness, overall care satisfaction, and improved quality of life.

Responsibilities

• Directs 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.
• Congnates with external sources to include: providers, vendors, facilities, social workers/case managers and/or community services.
• Participates in team training and continuing medical education.
• Presents for external audits and quality assurance efforts.

Requirements

• The typical work hours are Monday - Friday from 8:30am - 5pm.
• This is a full-time remote position.

Qualifications

• Associate’s degree in Nursing; OR Graduate of Accredited School of Nursing; OR Master's degree in Social Work, Psychology, or Counseling (Div. 75 and 6B) only.
• 5 years' case management experience or 2 years’ case manager experience in a health insurance environment.

Skills

• 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.
• 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 creative thinking skills.
• Ability to handle confidential or sensitive information with discretion.

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