Case Manager

Job Description Join our team as an RN Case Manager, a vital member of our Population Health team, working fully remote and embedded within an interdisciplinary team. Our ideal candidate will engage with members through telephonic outreach, utilizing critical thinking for assessment, planning, and implementation. You will find fulfillment in supporting our members with personalized care coordination, empowering them with tools, education, and self-care coaching to achieve long-term lifestyle changes. This role is designed to improve member outcomes, be cost-effective, and promote positive operational results. We seek a dedicated, caring, and compassionate individual who is organized, has excellent communication skills, and is proficient with technology. Notes: The RN should hold a compact license. CCM certification is not required but is preferred. Business hours are 8-6 EST, with leadership working with each case manager to establish a schedule within these hours, allowing for adjustments to meet member needs. A commitment to leveraging AI-enabled tools and technology to improve efficiency, streamline processes, and support continuous operational improvement. 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. 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. Job Qualifications 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. Experience 3 years - Clinical experience required. Experience 5 years - Experience in the health care industry. For Select Community and Katie Beckett: 2 years experience in IDD for Select Community is required. Skills/Certifications: 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. Job Details Number of Openings Available: 1 Worker Type: Employee Company: BCBST BlueCross BlueShield of Tennessee, Inc. EEO Statement BCBST will 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. Recruitment Disclaimer 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. Company Overview As Tennessee's largest health benefit plan company, we've been helping Tennesseans find their own unique paths to good health since 1945. More than that, we're your neighbors and friends – fellow Tennesseans with deep roots of caring tradition, a focused approach to physical, financial and community good health for today, and a bright outlook for an even healthier tomorrow. At BCBST, we empower our employees to thrive both independently and collaboratively, creating a collective impact on the lives of our members. We seek talented individuals who excel in a team environment, share responsibility, and embrace accountability. We're also seeking candidates who are proficient in the Microsoft Office suite, including Microsoft Teams, organized, and capable of managing multiple assignments or projects simultaneously. Additional, strong interpersonal abilities along with strong oral and written communication skills are important across all roles at BCBST. We foster a culture where innovation is encouraged. That includes using AI enabled tools responsibly to support everyday work — guided by proven workflows, templates, and policies. As roles become more advanced, we expect employees to leverage AI more broadly to transform how we serve members. BCBST is a remote-first organization with many employees working primarily from their homes. Each position within the company is classified as either fully remote, partially remote, or office based. BCBST hires employees for remote positions from across the U.S. with the exception of the following states: California, Massachusetts, New Hampshire, New Jersey, and New York. Applicants living in these states may move to an approved state prior to starting a position with BCBST at their own expense. If the position requires the individual to reside in Chattanooga, TN, they may be eligible for relocation assistance. #J-18808-Ljbffr