BlueCross BlueShield of South Carolina logo
BlueCross BlueShield of South Carolina

South Carolina’s largest and oldest health insurance company

RN Case Management Coordinator

GeneralGeneralFull TimeRemoteSeniorTeam 10,001+Since 1946H1B No SponsorCompany SiteLinkedIn

Location

South Carolina

Posted

7 hours ago

Salary

0

Seniority

Senior

Associate Degree4 yrs expExperience acceptedEnglish

Job Description

RN Case Management Coordinator

BlueCross BlueShield of South Carolina

• 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 • Participates in direct intervention/patient education with members and providers regarding health care delivery system • 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 health care providers and members • Performs medical or behavioral review/authorization process • Ensures coverage for appropriate services within benefit and medical necessity guidelines • Identifies and makes referrals to appropriate staff

Job Requirements

  • Associates in a job-related field
  • 4 years recent clinical in defined specialty area or 4 years utilization review/case management/clinical/or combination (2 of the 4 years must be clinical)
  • Working knowledge of word processing software
  • Knowledge of quality improvement processes
  • 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.
  • An active, unrestricted RN license from the United States and in the state of hire OR active compact multistate unrestricted RN license OR active, unrestricted licensure as social worker OR active, unrestricted licensure as counselor, or psychologist

Benefits

  • 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

Related Categories

Related Job Pages

More General Jobs

Aqua Finance, Inc. logo

Resolution Specialist

Aqua Finance, Inc.

Aqua provides flexible financing programs to dealers, contractors, and retailers so families can realize their dreams.

General7 hours ago
Full TimeRemoteTeam 201-500Since 1985H1B No Sponsor

• Monitoring, tracking, researching, and responding to borrower complaints received through non-regulatory channels • One-call resolution on complaint calls • 2nd level support to assist agents with supervisor calls and answering questions • Ongoing monitoring of complaints and disputes across all channels • Research borrower’s accounts, documents, etc. against the complaints received • Write a clear summary of the problem and resolution • Perform professional and comprehensive issue resolution and service to build strong dealer relationships • Work with various departments to facilitate resolution

Illinois + 2 moreAll locations: Illinois | North Carolina | Minnesota
RH Mosaico logo

Insurance Sales Representative

RH Mosaico

Conectamos talentos, construímos resultados.

General7 hours ago
Full TimeRemoteTeam 1-10Since 2023H1B No Sponsor

• Conduct active and inbound prospecting of clients (individuals and businesses). • Present and offer insurance products and services according to the client's profile and needs. • Provide consultative service, delivering clear and concise information about coverages, terms, and benefits. • Lead negotiations and close sales. • Monitor ongoing proposals and provide post-sale support. • Keep the CRM up to date with contact records and opportunities. • Work in alignment with the team and follow the insurance brokerage's commercial guidelines.

Brazil
Full TimeRemoteTeam 10,001+Since 1990H1B No Sponsor

• Oversee and coordinate the preparation, negotiation, and execution of clinical trial agreements and budgets for assigned studies or portfolios • Manage end-to-end site contracting activities for assigned studies, including template use, negotiation, and execution tracking • Serve as a primary escalation point for contract issues, proposing solutions that balance sponsor, site, and internal requirements • Collaborate with legal, finance, and project teams to ensure alignment on contract language, budget assumptions, and risk positions • Monitor contracting timelines and metrics, identifying bottlenecks, and driving corrective actions to improve cycle times • Provide guidance and oversight to Site Contracts Negotiators working on the same studies or programs • Contribute to the development and refinement of contracting playbooks, templates, and standard processes

Pennsylvania
General7 hours ago
Full TimeRemoteTeam 1,001-5,000H1B No Sponsor

• Heavy phone communication with customers, utilizing a variety of software tools to navigate customer accounts, process online sales and returns • Represents Tommy Bahama through direct and professional interaction with our guests both verbally and in writing • Responsible for coordinating credit approvals and fulfillment of all online orders • Troubleshoots guest issues with orders and general product inquiries • Provides product recommendations and substitutions as appropriate • Escalates guest issues efficiently and to the right place for resolution • Other special projects as requested by supervisor

Arizona + 2 moreAll locations: Arizona | Florida | Texas