Summary Join our National Alliance Care Management team. National Alliance provides care management services to more than 2 million members in South Carolina and nationally. This position is unique in that it is dedicated exclusively to the largest account with National Alliance. Resulting in expert knowledge in a single plan's benefits.
Administers complex, high-touch concierge case management for members identified into specialized programs such as Cancer, Palliative Care, high-risk maternity, NICU, ESRD, or Behavioral Health. Identifies risks and provides 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. Description Logistics This position is full time (40 hours/week) Monday-Friday and will be fully remote (). To work from home, you must have high-speed internet (non-satellite) and a private home office (non-shared space that is lockable). What You Will Do 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 to include 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. To Qualify For This Position, You Will Need Required License: 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). Nationally recognized Case Management certification to be obtained within two years of hire as a Case Manager. Required Education: Associate's degree in Nursing; OR Graduate of Accredited School of Nursing. Work Experience: Five years' experience in case management OR two years' case manager experience 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 What We Prefer Bachelor's degree in 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 services 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 specialty area. What We Can Do for You 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. 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 a recruiter to verify resume specifics and salary requirements. Management will be conducting interviews with the most qualified candidates.
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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.
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