Nurse Care Manager
BlueCross BlueShield Of Tennessee
R-24357
vor 5 Tg.

Manages member care and progress for cases with multiple levels of risk.

Job Description : Job Responsibilities

Job Responsibilities

  • Supporting utilization management functions for more complex and non-routine cases as needed.
  • Serving as a liaison between members, providers and internal / external customers in coordination of health care delivery and benefits programs.
  • Overseeing highly complex cases identified through various mechanisms to ensure effective implementation of interventions, and to ensure efficient utilization of benefits
  • Performing the essential activities of case management : assessment : planning, implementation, coordinating, monitoring, outcomes and evaluation.
  • Various immunizations & / or associated medical tests may be required for this position.
  • Testing / Assessments will be required for Digital positions.
  • Experience

  • 3 years - Clinical experience required
  • 5 years - Experience in the health care industry
  • Skills Certifications

  • Currently has a Certified Case Manager (CCM) credential or must obtain certification within 2 years of hire.
  • Excellent oral and written communication skills
  • PC Skills required (Basic Microsoft Office and E-Mail)
  • License

  • Registered Nurse (RN) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law.
  • Job Specific Requirements :

    Strong preference for candidates who have pediatric experience preferably from an acute care setting, with demonstrated clinical expertise in caring for medically fragile children with complex medical and / or behavioral health needs.

    The Nurse Care Manager will assess for child development and milestones to provide resources for deficiencies identified.

  • The Nurse Care Manager will identify goals and challenges through the person and family- centered planning process and identify needed home and community-based services;
  • as well as, coordinate additional Medicaid benefits to include medical and behavioral health services which may not be covered through the child’s primary payer.

    Employees who are required to operate either a BCBST-owned vehicle or a personal or rental vehicle for company business on a routine basis* will be automatically enrolled into the BCBST Driver Safety Program.

  • The employee will also be required to adhere to the guidelines set forth through the program. This includes, maintaining a valid driver’s license, auto insurance compliance with minimum liability requirements;
  • as defined in the Use of Non BCBST-Owned Vehicle Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR).

  • The definition for "routine basis" is defined as daily, weekly or at regularly schedule times.
  • Number of Openings Available :

    Worker Type : Employee

    Worker Sub-Type : Telecommuter

    Company :

    VSHP Volunteer State Health Plan, Inc

    Applying for this job indicates your acknowledgement and understanding of the following statement :

    BCBST is an Equal Opportunity employer (EEO), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made.

    BCBST will take affirmative action to recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

    Further information regarding BCBST's EEO Policies / Notices may be found by reviewing the following page :

    BCBST's EEO Policies / Notices

    BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity.

    All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR / Talent Acquisition will not be considered.

    No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

    Tobacco-Free Hiring Statement

    To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits.

    A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community.

    All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco / nicotine test.

    An individual whose post offer screening result is positive for illegal drugs or tobacco / nicotine and / or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results.

    Resources to help individuals discontinue the use of tobacco / nicotine products include smokefree.gov or 1-800-QUIT-NOW.

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