RN Case Manager (Home Health) - Middle Tennessee - Member Visits Required at BlueCross BlueShield of Tennessee

About the position

The position involves supporting utilization management functions for complex and non-routine cases, acting as a liaison between members, providers, and both internal and external customers to coordinate health care delivery and benefits programs. The role requires overseeing highly complex cases identified through various mechanisms to ensure effective implementation of interventions and efficient utilization of benefits. Essential activities of case management include assessment, planning, implementation, coordination, monitoring, outcomes, and evaluation. For digital positions, effective communication via digital channels is crucial, along with technical support capabilities. Candidates must demonstrate proficiency in typing and grammar, as well as pass standard Windows Testing. Additionally, this position mandates an 18-month commitment before applying for other internal positions, effective from July 22, 2013.

Responsibilities
• Supporting utilization management functions for complex and non-routine cases.
,
• Serving as a liaison between members, providers, and internal/external customers in coordination of health care delivery and benefits programs.
,
• Overseeing highly complex cases to ensure effective implementation of interventions and efficient utilization of benefits.
,
• Performing essential activities of case management including assessment, planning, implementation, coordination, monitoring, outcomes, and evaluation.
,
• Communicating effectively via digital channels and providing technical support as needed.

Requirements
• Registered Nurse (RN) with an active license in the state of Tennessee or a participating state in the Nurse Licensure Compact Law.
,
• 3 years of clinical experience required; 5 years of experience in the health care industry preferred.
,
• For Select Community & Katie Beckett: 2 years of experience in IDD is required.
,
• Currently holds a Certified Case Manager (CCM) credential or must obtain certification within 2 years of hire.
,
• For Select Community & Katie Beckett: Certification in Developmental Disabilities Nursing (CDDN) is required at hire or must be attained within 3 years.
,
• Excellent oral and written communication skills are essential.
,
• Basic PC skills required, including proficiency in Microsoft Office and email.

Nice-to-haves

Benefits

Apply Job!