Medical Case Manager (Hamblen, Greene County)

About the role

SelectCommunity at BCBST is seeking a Registered Nurse Case Manager who is compassionate about case management, advocating for the social, emotional, functional, mental, behavioral, and physical health of individuals with intellectual and developmental disabilities. In this role, the SelectCommunity Nurse Care Manager (NCM) assesses members’ current status, facilitates coordination of long‑term services and supports under insurance benefits and Department of Disability and Aging benefits, collaborates with members, caregivers, conservators, and providers to develop individual, integrated plans of care based on health needs, and monitors progress for members with multiple levels of acuity. The role requires telephonic contacts and in‑person home visits with members at least monthly and as required by the TennCare Contract. Candidates must reside in Hamblen or Greene County, TN, as travel is required to meet with members.

Responsibilities

• Support utilization management functions for more complex and non‑routine cases as needed.
• Serve as a liaison between members, providers, and internal/external customers in coordination of health care delivery and benefits programs.
• Oversee highly complex cases identified through various mechanisms to ensure effective implementation of interventions and efficient utilization of benefits.
• Perform the essential activities of case management: assessment, planning, implementation, coordination, monitoring, outcomes, and evaluation.
• Ability to effectively communicate via digital channels and offer technical support.
• Effective 7/22/13: This position requires an 18‑month commitment before posting for other internal positions.
• Various immunizations and/or associated medical tests may be required for this position.
• This job requires a digital literacy assessment.

Qualifications

• Registered Nurse (RN) with an active license in the state of Tennessee, or hold a license in the state of residence if the state participates in the Nurse Licensure Compact Law.
• Minimum 3 years of clinical experience.
• Minimum 5 years of experience in the healthcare industry.
• For Select Community & Katie Beckett: 2 years of experience in IDD required.

Skills

• Excellent oral and written communication skills.
• PC skills required (Basic Microsoft Office and E‑Mail).
• Ability to operate a BCBST‑owned, personal, or rental vehicle for company business on a routine basis; participation in the BCBST Driver Safety Program required, including maintaining a valid driver’s license, auto insurance meeting minimum liability requirements, and an acceptable motor vehicle record (MVR).