Job Overview
Employment Type
Full-time
Compensation
Hourly
Range $18.50 - $23.50
Work Schedule
Standard Hours
Benefits
subsidized health plans
dental coverage
vision coverage
401k Retirement Savings Plan with company match
Life insurance
Paid Time Off
Education Assistance
Service recognition
National discounts
Job Description
BlueCross BlueShield of South Carolina is a prominent healthcare insurance provider with a strong presence both within South Carolina and nationally. Established for over seven decades, the company has grown to become the largest insurance provider in South Carolina. It is renowned not only for providing healthcare coverage but also for being a leading administrator of government contracts and operating one of the most sophisticated data processing centers in the Southeast region. The company's diverse family of subsidiary businesses further expands its reach and capabilities, enabling comprehensive healthcare solutions tailored to a variety of members' needs. BlueCross BlueShield is deeply embedded in the local community and remains committed to supporting the health and wellbeing of over two million members it serves. The company underscores a service-oriented culture dedicated to outstanding customer care and community engagement, making it an appealing employer for those who share these values.
This role focuses on providing care management services through a high-touch, concierge case management approach. It primarily involves supporting members enrolled in specialized healthcare programs such as high-risk maternity, neonatal intensive care (NICU), end-stage renal disease (ESRD), cancer care, palliative care, and behavioral health. The position requires identifying healthcare risks and facilitating outreach efforts to coordinate services effectively, close care gaps, and ensure members receive tailored, comprehensive care plans that maximize cost efficiency and promote improved quality of life. This is a full-time remote position with typical hours from Monday to Friday, 8:30 am to 5:00 pm, enabling work-life balance and flexibility.
The care manager will play a vital role in directing day-to-day management activities for high-risk members. Responsibilities include coordinating treatment plans, working closely with various healthcare providers, vendors, social workers, community services, and other stakeholders to align clinical services seamlessly. Additionally, this role involves participating in team training, continuing medical education, and preparing for audits and quality assurance initiatives. The ideal candidate will bring a strong nursing or social work background combined with case management experience in either healthcare or health insurance environments, demonstrating excellent organizational, communication, analytical, and decision-making skills. Proficiency with Microsoft Office and case management software tools is essential. Certification and active licensure in nursing or behavioral health-related fields are required, with opportunities to obtain nationally recognized case management certification within two years. This position supports and promotes the values of diversity, inclusion, and equal opportunity, offering a supportive and dynamic work environment where careers can flourish.
This role focuses on providing care management services through a high-touch, concierge case management approach. It primarily involves supporting members enrolled in specialized healthcare programs such as high-risk maternity, neonatal intensive care (NICU), end-stage renal disease (ESRD), cancer care, palliative care, and behavioral health. The position requires identifying healthcare risks and facilitating outreach efforts to coordinate services effectively, close care gaps, and ensure members receive tailored, comprehensive care plans that maximize cost efficiency and promote improved quality of life. This is a full-time remote position with typical hours from Monday to Friday, 8:30 am to 5:00 pm, enabling work-life balance and flexibility.
The care manager will play a vital role in directing day-to-day management activities for high-risk members. Responsibilities include coordinating treatment plans, working closely with various healthcare providers, vendors, social workers, community services, and other stakeholders to align clinical services seamlessly. Additionally, this role involves participating in team training, continuing medical education, and preparing for audits and quality assurance initiatives. The ideal candidate will bring a strong nursing or social work background combined with case management experience in either healthcare or health insurance environments, demonstrating excellent organizational, communication, analytical, and decision-making skills. Proficiency with Microsoft Office and case management software tools is essential. Certification and active licensure in nursing or behavioral health-related fields are required, with opportunities to obtain nationally recognized case management certification within two years. This position supports and promotes the values of diversity, inclusion, and equal opportunity, offering a supportive and dynamic work environment where careers can flourish.
Job Requirements
- Associate's degree in nursing or graduate of accredited school of nursing or master’s degree in social work, psychology, or counseling (Div. 75 and 6B) only
- 5 years’ case management experience or 2 years’ case manager experience in a health insurance environment
- 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
- Microsoft Office proficiency
- 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 (Behavioral Health positions only)
- Nationally recognized case management certification to be obtained within 2 years of hire as a Case Manager
Job Qualifications
- Associate's degree in nursing or graduate of accredited school of nursing or master’s degree in social work, psychology, or counseling (Div. 75 and 6B) only
- 5 years’ case management experience or 2 years’ case manager experience in a health insurance environment
- 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
- Microsoft Office proficiency
- 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 (Behavioral Health positions only)
- Nationally recognized case management certification to be obtained within 2 years of hire as a Case Manager
Job Duties
- 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 including 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
Job Criteria
Experience
Mid Level (3-7 years)
Job Location
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