Women's Healthcare Case Manager

BlueCross BlueShield of Tennessee seeks an experienced RN to provide compassionate, member-centered care for women navigating women’s health conditions; from pregnancy to perimenopausal related. This role involves telephonic and digital outreach, education, and care coordination with providers to ensure timely, personalized support. In this role, you will:

• Assess member needs and create individualized care plans.
• Educate and support members through some of life’s most complex transitions.
• Coordinate care with OB/GYNs, PCPs, and behavioral health specialists
• Monitor progress, adjust plans, and advocate for access and adherence

You will be an ideal candidate for this role, if, in addition to the required qualifications, you:

• Are passionate about women’s health, skilled at building trust, and motivated to empower members through complex health transitions.
• Have 3+ years of experience in women's healthcare (maternity, GYN, women’s health)
• Are tech-savvy, adaptable, and comfortable in a remote setting
• Have excellent communication, empathy, and problem-solving skills
• Appreciate continuous program 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
• 5 years - Experience in the health care industry
• For Select Community & Katie Beckett: 2 years experience in IDD for Select Community is required

SkillsCertifications

• Currently has a Certified Case Manager (CCM) credential or must obtain certification within 2 years of hire.
• For Select Community & Katie Beckett: In addition to CCM, Certification in Developmental Disabilities Nursing (CDDN) is required at hire, or must be attained within 3 years.
• Excellent oral and written communication skills
• PC Skills required (Basic Microsoft Office and E-Mail)

Grade 10 BBEX Incentive Plan AEP Number of Openings Available 1Worker Type: EmployeeCompany: BCBST BlueCross BlueShield of Tennessee, Inc. Applying for this job indicates your acknowledgement and understanding of the following statements: 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 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. Apply tot his job Apply To this Job