Medical Case Manager

BlueCross BlueShield of Tennessee • Memphis, TN

1d • Remote

About The Position

We are hiring a Home Health Case Manager at BCBST! In this role, you will support TennCare (Medicaid) members with complex medical, functional and social needs. You will coordinate home and community-based care, conduct required home visits, and support members transitioning to adult benefits. You’ll collaborate closely with providers and internal care teams using digital tools to identify care gaps, reduce hospitalization risk, and improve outcomes. To be successful in this role, in addition to the core job requirements, you'll bring strong clinical judgement, experience using digital tools to communication, and availability for home visits. You will be a strong candidate for this role if you have the following: home health or hospice nursing experience, pediatric experience, knowledge of MTLSS programs, and familiarity with community-based services. Note: This is a remote, Monday–Friday (8:00 a.m.–5:00 p.m.) role with flexibility to support member needs, however this role requires traveling to members' homes monthly in the Memphis area. Candidates must live within 50 miles of Memphis. Sponsorship is not available for this role.

Requirements

• 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.
• 3 years - Clinical experience required
• 5 years - Experience in the health care industry
• For Select Community & Katie Beckett: 2 years experience in IDD for Select Community is required
• Excellent oral and written communication skills
• PC Skills required (Basic Microsoft Office and E-Mail)
• 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.

Nice To Haves

• home health or hospice nursing experience
• pediatric experience
• knowledge of MTLSS programs
• familiarity with community-based services

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.
• Digital positions must have the ability to effectively communicate via digital channels and offer technical support.
• Effective 7/22/13: This Position requires an 18 month commitment before posting for other internal positions.
• Various immunizations and/or associated medical tests may be required for this position.
• This job requires digital literacy assessment.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed