RN Case Manager - *Must reside within 50 miles of Ridgeland, MS* at BlueCross BlueShield of Tennessee

About the position

The position involves managing member care and progress for cases with varying levels of risk, focusing on complex and non-routine cases. The role requires supporting utilization management functions and acting as a liaison between members, providers, and both internal and external customers to coordinate healthcare delivery and benefits programs. The individual will oversee highly complex cases identified through various mechanisms, ensuring effective implementation of interventions and efficient utilization of benefits. Essential activities of case management include assessment, planning, implementation, coordination, monitoring, outcomes, and evaluation. For digital positions, effective communication via digital channels is crucial, along with the ability to provide technical support. Candidates must demonstrate proficiency in typing and grammar, as well as pass standard Windows testing. Additionally, there is a requirement for an 18-month commitment before applying for other internal positions, effective from July 22, 2013.

Responsibilities
?? Support utilization management functions for complex and non-routine cases as needed.
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?? Serve as a liaison between members, providers, and internal/external customers in coordinating healthcare delivery and benefits programs.
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?? Oversee highly complex cases to ensure effective implementation of interventions and efficient utilization of benefits.
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?? Perform essential activities of case management including assessment, planning, implementation, coordination, monitoring, outcomes, and evaluation.
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?? Communicate effectively via digital channels and provide technical support as required.

Requirements
?? Registered Nurse (RN) with an active license in the state of Tennessee or a participating state in the Nurse Licensure Compact Law.
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?? 3 years of clinical experience required; 5 years of experience in the healthcare industry preferred.
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?? For Select Community & Katie Beckett: 2 years of experience in IDD is required.
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?? Currently holds a Certified Case Manager (CCM) credential or must obtain certification within 2 years of hire.
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?? For Select Community & Katie Beckett: Certification in Developmental Disabilities Nursing (CDDN) is required at hire or must be attained within 3 years.
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?? Excellent oral and written communication skills are essential.
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?? Basic PC skills required, including proficiency in Microsoft Office and email.

Nice-to-haves

Benefits
?? Remote-first work environment with flexibility in work location.
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?? Potential relocation benefits for applicants moving to Chattanooga, TN.

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