Concierge Care Manager

We are currently hiring for a Concierge Care Manager to join BlueCross BlueShield of South Carolina. In this role as Concierge Care Manager, you will provide care management services to more than 2 million members in South Carolina and nationally. You will administer complex, high-touch concierge case management for members identified into specialized programs such as high-risk maternity, NICU, ESRD, and Palliative Care Behavioral Health. You will also identify risks and provide 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.

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.

• 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.
• Coordinates clinical services with external sources, including providers, vendors, facilities, social workers/case managers, and/or community services.
• Participates in team training and continuing medical education.
• Prepares for external audits and quality assurance efforts.

• 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).
• Five years’ case management experience as a RN OR two years’ case manager experience as a RN in a health insurance environment.
• 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.
• Microsoft Office.
• 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 (Div. 75 only).
• Nationally recognized case management certification will be obtained within two years of hiring as a case manager.

• Bachelor’s degree in a health-related field (Nursing, Healthcare Administration, Pharmacy, Sciences, Applied Health).
• Five years experience in case management in a sub-specialty area (i.e., ICU, Palliative Care, Hospice, OR Home Health).
• 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.
• Case manager certification, clinical certification in a specialty area.
• Basic Life Support (BLS) OR Advanced Cardiac Life Support (ACLS) certification.

• 401(k) retirement savings plan with company match.
• Subsidized health plans and free vision coverage.
• Life insurance.
• Paid annual leave – the longer you work here, the more you earn.
• Nine paid holidays.
• On-site cafeterias and fitness centers in major locations.
• Wellness programs and healthy lifestyle premium discount.
• Tuition assistance.
• Service recognition.
• Incentive Plan.
• Merit Plan.
• Continuing education funds for additional certifications and certification renewal.