Building Location: 516 Building - Duluth Department: 1007540 INPATIENT CLINICAL APPS - EH SS Job Description: Provides a variety of services and high level support for the analysis of mid complexity projects along with the support and maintenance of EHR applications that are affected. Successfully leads initiatives and projects with other staff. Subject matter expert in assigned applications and works to develop a breadth of knowledge across applications. Develops, implements, and presents educational programs for end users. Responsibilities include mid complexity issues; acting as the liaison between customer and support staff to resolve issues; understanding and adhering to service provider/customer chain of accountability that ultimately leads to the patient. This position must be highly responsive to customers and show an aptitude for the translation of customer requirements into feasible options within the application. Duties also include planning and implementing technology learning programs, and assessing users during technology learning programs for successful competence. Works under general supervision. Education Qualifications: Educational Requirements: - Bachelor’s degree in Information Services, Business, Healthcare or related field of study plus 2 years of experience in Information Services, Business Services, Healthcare or related field OR - Associates degree and 4 years of experience in Information Services, Business Services or Healthcare. OR - 6 years of experience in Information Services, Business Services or Healthcare Licensure/Certification Qualifications: - Certification in Epic inpatient applications preferred FTE: 1 Possible Remote/Hybrid Option: Remote Shift Rotation: Day Rotation (United States of America) Shift Start Time: 8:00 AM Shift End Time: 4:30 PM Weekends: Holidays: No Call Obligation: Yes Union: Union Posting Deadline: Compensation Range: $66,539.20 - $99,819.20 Employee Benefits at Essentia Health: At Essentia Health, we’re committed to supporting your well-being, growth, and work-life balance. Our comprehensive benefits include medical, dental, vision, life, and disability insurance, along with supplemental options to fit your needs. We offer a 401(k) plan with employer contributions to help you plan for the future, and we invest in your professional development through training, tuition reimbursement, and educational programs. To help you thrive both at work and at home, we provide flexible scheduling, generous time off, and wellness resources focused on your physical, mental, and emotional health. Please note that benefit eligibility may vary. For full details, refer to your benefit summary or contact our HR Service Center at (218) 576-0000.

Summary We are currently hiring for a Case Management Coordinator to join BlueCross BlueShield of South Carolina. In this role as a Case Management Coordinator, care management interventions focus on improving care coordination and reducing the fragmentation of the services the recipients of care often experience, especially when multiple health care providers and different care settings are involved. Taken collectively, care management interventions are intended to enhance client safety, well-being, and quality of life. These interventions carefully consider health care costs through the professional care manager's recommendations of cost-effective and efficient alternatives for care. Thus, effective care management directly and positively impacts the health care delivery system, especially in realizing the goals of the "Triple Aim," which include improving the health outcomes of individuals and populations, enhancing the experience of health care, and reducing the cost of care. The professional care manager performs the primary functions of assessment, planning, facilitation, coordination, monitoring, evaluation, and advocacy. Integral to these functions is collaboration and ongoing communication with the client, client's family or family caregiver, and other health care professionals involved in the client's care. Description Location This position is full-time (40 hours/week) Monday-Friday from 8:30am-5:00pm and will be fully remote within SC. What You’ll Do: - Provides active care management, assesses service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans, to include member goals. Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions. Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits. Provides telephonic support for members with chronic conditions, high-risk pregnancy or other at-risk conditions that consist of: intensive assessment/evaluation of condition, at-risk education based on members’ identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement. - Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans. May identify, initiate, and participate in on-site reviews. Serves as member advocate through continued communication and education. Promotes enrollment in care management programs and/or health and disease management programs. - Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members. - Performs medical or behavioral review/authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines. Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.). Participates in data collection/input into system for clinical information flow and proper claims adjudication. Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal). - Maintains current knowledge of contracts and network status of all service providers and applies appropriately. Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services. To Qualify for This Position, You'll Need the Following: - Required Education: Associates in a job-related field. - Degree Equivalency: Graduate of Accredited School of Nursing OR 2 years job related work experience. - Required Experience: 4 years recent clinical in defined specialty area. Specialty areas include: oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedics, general medicine/surgery. Or, 4 years utilization review/case management/clinical/or combination; 2 of the 4 years must be clinical. - 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. - Good judgment skills. - 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 critical thinking skills. - Ability to handle confidential or sensitive information with discretion. - Required Software and Tools: Microsoft Office. - Required License/Certificate: An active, unrestricted RN license 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, unrestricted licensure as counselor, or psychologist from the United States and in the state of hire (in Div. 75 only). For Div. 75 and Div. 6B, except for CC 426: URAC recognized Case Management Certification must be obtained within 4 years of hire as a Case Manager. We Prefer That You Have the Following: - Preferred Work Experience: Previous experience in Pediatrics - Prior knowledge of Medicaid - 7 years-healthcare program management. - Preferred Education: Bachelor's degree- Nursing - Preferred Skills and Abilities: Bilingual in Spanish - Working knowledge of spreadsheet, database software. Thorough knowledge/understanding of claims/coding analysis, requirements, and processes. - Preferred Licenses and Certificates: Case Manager certification, clinical certification in specialty area. Our Comprehensive Benefits Package Includes the Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits for the first of the month following 28 days of employment. - Subsidized health plans, dental and vision coverage - 401k retirement savings plan with company match - Life Insurance - Paid Time Off (PTO) - On-site cafeterias and fitness centers in major locations - Education Assistance - Service Recognition - National discounts to movies, theaters, zoos, theme parks and more What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. 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 our recruiter to verify resume specifics and salary requirements. Management will conduct interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications. 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 individuals with disabilities and protected 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. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. 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• Partner with the Senior Director of Product to support team OKRs, capacity planning, product ops, and cross-functional coordination. • Contribute to strategic initiative planning, including market scans, opportunity assessments, and portfolio-wide analysis. • Help prepare executive updates, product review materials, and cross-team communication artifacts. • Work with Product Managers across different visit offerings to support requirement documentation, user research, backlog organization, and MVP delivery. • Analyze operational and clinical data to identify areas for improvement or product iteration. • Support end-to-end product lifecycle—from discovery and business case development to launch tracking and retrospective reviews. • Conduct qualitative and quantitative research to evaluate new product opportunities, care models, and market trends. • Support value proposition development by analyzing member, provider, and client needs alongside market and competitive benchmarks. • Perform product performance analysis to identify areas for enhancement across engagement, conversion, operational throughput, and clinical outcomes. • Support operational improvement analysis to uncover bottlenecks or inefficiencies in delivery workflows and inform process or product changes. • Support collection, synthesis, and interpretation of member and provider feedback to inform product iteration and improve experience design. • Develop decision-support tools, dashboards, and trackers to provide visibility into product performance and pipeline. • Build competitor scans and benchmarks that inform product strategy and differentiation. • Support team to coordinate team planning activities such as quarterly and annual planning, cross-team standups, and stakeholder reviews. • Maintain centralized team documentation (e.g., roadmaps, Confluence pages, templates). • Serve as the go-to for synthesizing inputs from clinical, ops, engineering, and finance into actionable deliverables for the product team.

• Partner with HR, Payroll, and Finance teams to enhance and maintain Workday HCM modules (Talent, Payroll for U.S., Time Tracking, Absence, Advanced Compensation, Core HCM, and Reporting). • Configure business processes, condition rules, calculated fields, and validation rules to meet evolving business needs. • Develop and maintain custom reports and dashboards that deliver actionable insights. • Collaborate with stakeholders to support end-to-end HR and payroll processes, including hiring, onboarding, performance, compensation, and terminations. • Participate in Workday release management by assessing new features, coordinating testing, and implementing updates. • Support integrations between Workday and internal/external systems (benefits, finance, time tracking, etc.). • Troubleshoot and resolve system issues in collaboration with team members and functional partners. • Maintain documentation and promote data accuracy, consistency, and compliance.