RN Behavioral Health Concierge Care Manager

This full-time (40 hours/week) position is fully remote, with a schedule of Monday-Friday from 8:00am-5:00pm EST. Candidates must have high-speed (non-satellite) internet and a private, secure home office.

About the role

As an RN Behavioral Health Concierge Care Manager, you will provide care management services to more than 2 million members in South Carolina and nationally. This role involves administering complex, high-touch concierge case management for members in specialized programs such as high-risk maternity, NICU, ESRD, Cancer, Palliative Care, or Behavioral Health. You will identify risks, provide outreach services to facilitate coordination of healthcare services, close gaps in care, and develop individualized care plans to ensure cost-effectiveness, overall care satisfaction, and improved quality of life.

Most interactions will be by phone and through our messaging system. You will educate and guide members through prior authorizations, medication adherence, and the plan of care. Members will include those with chronic or high-risk conditions and those admitted to inpatient care.

Responsibilities

• Direct day-to-day, high-touch member management, including 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 such as 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.

Requirements

• Associate’s degree in nursing OR graduate of an accredited School of Nursing OR master’s degree in social work, Psychology, or Counseling.
• 5 years' case management experience OR 2 years’ case management experience in a health insurance environment.
• Active, unrestricted RN licensure 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 licensure as a social worker, psychologist, or counselor in the state of hire.
• Nationally recognized Case Management certification to be obtained within 2 years of hire as a Case Manager.
• Working knowledge of word processing software and Microsoft Office.

Skills

• 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.
• Proficiency in spelling, punctuation, and grammar.
• Strong 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.

Preferred Qualifications

• Bachelor's degree in a health-related field (Nursing, Healthcare Administration, Pharmacy, Sciences, Applied Health).
• Previous experience in an Autism specialty or working with autistic patients.
• 5 years’ experience in case management in a sub-specialty area (e.g., ICU, Palliative Care, Hospice, or Home Health).
• Case manager certification or clinical certification in a specialty area.
• Basic Life Support (BLS) or Advanced Cardiac Life Support (ACLS) certification.
• Strong communication and customer service skills.
• Excellent analytical skills to problem-solve and remedy issues immediately.
• Ability to work in an autonomous environment or leadership capacity.
• Working knowledge of Microsoft Word, PowerPoint, Excel, or other spreadsheet/database software; TMCS, LiveOps, MDDS, and BlueVue.

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.

Benefits are eligible from the first of the month following 28 days of employment.

Pay

Pay range minimum: $57,790.00

Pay range midpoint: $84,089.00

Pay range maximum: $110,388.00

Compensation decisions within the range will depend on factors such as experience, geographic location, and internal equity.