New

Concierge Care Manager

BlueCross BlueShield of South Carolina
life insurance, paid time off, tuition reimbursement, 401(k), remote work
United States, Nebraska, Omaha
Apr 01, 2025
Summary 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 medical case management. Identify risks and provide outreach services to facilitate the coordination of healthcare services and gap closure. Provides individualized care plans to ensure improved quality of life, cost-effectiveness, and overall care satisfaction. The position will be working from home on a desktop computer to provide highly interactive case management to assigned members. Members will include those with chronic or high-risk conditions and those who are admitted to inpatient care. Educating and guiding members through prior authorizations and understanding the need to adhere to medications and the plan of care. Most interactions will be by phone and through our messaging system. Perfect for those who love case management and improving the lives and medical outcomes of members while working in your own home office. 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 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! Having over 15,000 employees across the country opens a lot of career opportunities. You can move up within your line of business or move to another one of our lines of business. You retain your tenure and benefits while growing your career in a different area. This is not possible at most smaller organizations. We also offer a generous education reimbursement program to prepare you for future career growth. Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future. Description Logistics: About Us \| BlueCross BlueShield of South Carolina Location: This position is full time (40 hours/week) Monday-Friday and will be fully remote (Work at Home). To work from home, you must have high-speed (non-satellite) internet and a private, secure home office. What You'll Do: Direct 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. Coordinate clinical services with external sources, including providers, vendors, facilities, social workers/case managers, and/or community services. Participate in team training and continuing medical education. Prepare for external audits and quality assurance efforts. To Qualify for This Position, You'll Need the Following: Required Education: Associate's degree in nursing; OR Graduate of Accredited School of Nursing. For Div 75 and 6B requires Master's degree in Social Work, Psychology, or Counseling. Degree Equivalency: Degree Equivalency not applicable for the Celerian Group, Bachelor's degree required. 5 years' case management experience as a RN or 2 years' case manager experience as a RN in a health insurance environment. Required Skills and Abilities: 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. Required Software and Tools: Microsoft Office Required Licenses and Certificates: 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 to be obtained within 2 years of hire as a Case Manager. We Prefer That You Have the Following: Preferred Education: Bachelor's degree in health-related field (Nursing, Healthcare Administration, Pharmacy, Sciences, Applied Health) Preferred Work Experience: Work Experience: Stable work history in case management, strongly preferred. Five years of experience in case management in a sub-specialty area (i.e., Home Health, Critical Care, Hospital, OR Long-term Care). Prior work from home experience is a plus. Preferred Skills and Abilities: 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. Preferred Software and Tools: Working knowledge of Microsoft Word, PowerPoint, Excel, or other spreadsheet/database software; TMCS, LiveOps, MDDS, and BlueVue. Preferred Licenses and Certificates: Case manager certification, clinical certification in specialty area. Basic Life Support (BLS) or Advanced Cardiac Life Support (ACLS) certification. Our comprehensive benefits package includes the following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. 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 What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What to Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Pay Range Information: Range Minimum $ 59,718.00 Range Midpoint $ 86,801.00 Range Maximum $ 113,884.00 Pay Transparency Statement: Please note that this range represents the pay range for this and other positions that fall into this pay grade. Compensation decisions within the range will be dependent upon a variety of factors, including experience, geographic location, and internal equity. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Some states have required notifications. Here's more information. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or an accommodation while seeking employment, please e-mail mycareer.help@bcbssc.com or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.