RN Concierge Care Manager (Maternity/NICU)

About the role

We are currently hiring for an RN Concierge Care Manager to join BlueCross BlueShield of South Carolina. In this role, you will provide care management services to more than 2 million members in South Carolina and nationally.

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

Requirements

To qualify for this position, you'll need the following:

• A minimum of 5 years' case management experience or 2 years' case manager experience in a health insurance environment.
• A minimum of 5 years' experience in Maternity/ NICU.
• An 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 state of hire.
• Nationally recognized Case Management certification to be obtained within 2 years of hire as a Case Manager.

Qualifications

• A minimum of an Associate’s degree in nursing OR Graduate of Accredited School of Nursing OR master’s degree in social work, Psychology, or Counseling.
• Strong communication and customer services skills.
• Excellent analytical skills to problem solve and remedy issues immediately.
• Ability to work in an autonomous environment or leadership capacity.
• Strong analytical skills to problem solve and remedy issues immediately.
• Strong communication and customer services skills.

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

We offer a comprehensive benefits package that includes:

• 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