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BlueCross BlueShield of South Carolina
United States · remote · Salary not listed
This position is full-time (40 hours/week) Monday-Friday from 8:30am-5:00pm EST and will be fully remote. This position will require the candidate to spend most of their time traveling within a South Carolina region to conduct member-facing patient visits. This position offers mileage reimbursement after mile 50 with a reimbursement rate of 70 cents per mile, and a travel limit of 3-hours one way.
Our ideal candidate must reside in Low-Country Region of South Carolina, preferably Beaufort County.
Perform primary functions of assessment, planning, facilitation, coordination, monitoring, evaluation, and advocacy of assigned members. In person contact with the member is required. Collaborate and communicate with the member, member's family/caregiver and other healthcare professionals involved in the member’s care. Ensure care coordination and case management activities are aligned with members' risk levels and identified strengths, preferences, needs and desired outcomes. Assist with implementation of health management activities/programs for membership. Coordinate all aspects of assigned programs. Follow and assist with updates to updates of established procedures. Complete in-person assessments in the member’s residence or least restrictive environment. Participate in meetings concerning the member’s care. Utilize all data systems containing patient information and documents information appropriately.
Apply on source siteListed via Himalayas
Assist with development of strategies to increase effectiveness of and participation in health management programs. Establish and /maintain effective communications with provider network, group representatives and members.
Conduct research and analysis of reports (monthly, quarterly, annually). Adhere to NCQA requirements, state/federal regulations and CMSA standards. Monitor member compliance and success rate.
Assist with identification of areas for which there is a need for health management programs. Monitor quality indicators and identify programs to positively impact areas where improvement is warranted. Develop patient/provider educational materials for members/providers. Perform other duties as assigned.
Required Education: Bachelor's degree from an accredited university or college in Nursing, Health Administration, Health Promotion, Exercise Science, Education/Training, Social Work, or health-related field with a minimum of 45 documented training hours related to specialty area issues and treatment.
Degree Equivalency: If Behavioral Health Intensive Case Manager: 4-year degree in nursing, psychology, social work, early childhood education, child development or a related field with minimum of 45 documented training hours related to specialty area issues and treatment.
If Maternal Health Intensive Case Manager: 4-year degree in Health Promotion or related field OR 2-year degree and 2 years’ experience in healthcare environment or as a Certified Childbirth Educator/Prenatal Educator, OR graduate of an approved LPN program and 2 years’ experience in maternity management healthcare environment.
If Medical Health Intensive Case Manager: 4-year degree in Health Promotion, Exercise Science, or related field or Certified Asthma Educator or RRT (Registered Respiratory Therapist).
If Master's, 1 year experience may also be in Exercise Science, Nutrition, Physical Therapy, or other health-related degrees. If Wellness Coach/Health Promotion: 4-year degree in Health Administration, Health Promotion, Exercise Science, Education/Training, or health-related field.
Required Work Experience: At least 3 years’ experience working with people with specified health conditions.
If master’s degree, 2 years’ experience working with people with specified health condition.
Required Skills and Abilities: Working knowledge of word processing, spreadsheet, database, and presentation software.
Understanding of insurance and benefit programs as it relates to health management coverage.
Knowledge of the quality improvement process.
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.
Ability to persuade, negotiate, or influence others.
Ability to handle confidential or sensitive information with discretion.
Ability to drive and be available on nights and weekends.
Familiarity with evidenced based assessments.
Knowledge of national case management standards.
Required Software and Tools: Microsoft Office.
Required Licenses and Certificates: If RN, 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); if LPN, active, unrestricted LPN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted LPN license as defined by the Nurse Licensure Compact (NLC). If Social Worker, active, unrestricted LBSW (Licensed Bachelor of Social Worker (LBSW) or (Licensed Masters of Social Worker (LMSW), Licensed Independent Social Workers (LISW) from the United States and in the state of hire or with a state compact OR For Mental Health Professionals, active, unrestricted Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist, Licensed Addiction Counselors (LAC), Licensed Psycho-Educational Specialists (LPES), or Licensed Psychologist from the United States and in the state of hire or with a state compact.
Must have experience of working directly with individuals with mental illnesses.
Our Comprehensive Benefits Package Includes the Following:
We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.
Subsidized health plans, dental and vision coverage
401k retirement savings plan with company match
On-site cafeterias and fitness centers in major locations
National discounts to movies, theaters, zoos, theme parks and more
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.
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.
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 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. Here's more information.
Originally posted on Himalayas