Intensive Care Management Coordinator

Logistics: This position is full-time (40 hours/week) Monday through Friday and will be fully remote (W@H), with required member-facing patient visits within the South Carolina region.

What You Will Do:

• 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, the 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 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 document information appropriately.

• Assist with the development of strategies to increase the 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.

To Qualify for This Position, You Will Need:

• 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.

• If Behavioral Health Intensive Case Manager: four-year degree in nursing, psychology, social work, early childhood education, child development OR a related field with a minimum of 45 documented training hours related to specialty area issues and treatment.

• If Maternal Health Intensive Case Manager: four-year degree in Health Promotion, OR related field, OR two-year degree and two years experience in a healthcare environment, OR as a Certified Childbirth Educator/Prenatal Educator, OR graduate of an approved LPN program and two years experience in maternity management healthcare environment.

• If a medical health intensive case manager has a four-year degree in health promotion, exercise science, or a related field, is a certified asthma educator, or is an RRT (registered respiratory therapist),

• If you have a Master's, one year of experience may also be in Exercise Science, Nutrition, Physical Therapy, or another health-related degree.

• If Wellness Coach/Health Promotion: four-year degree in Health Administration, Health Promotion, Exercise Science, Education/Training, OR health-related field.

• At least three years' experience working with people with specified health condition.

• If you have a Master's degree and two years' experience working with people with specified health conditions.

• 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.

• Analytical OR critical thinking skills.

• Ability to handle confidential OR sensitive information with discretion.

• Ability to drive and be available on nights and weekends.

• Familiarity with evidence-based assessments.

• Knowledge of national case management standards.

• Microsoft Office.

• 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 a 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.

Our comprehensive benefits package includes the following:

• 401(k) retirement savings plan with company match

• Fantastic health plans and free vision coverage

• Life insurance

• Paid annual leave - the longer you work here, the more you earn

• Nine paid holidays

• On-site cafeterias and fitness centers in significant locations

• Wellness programs and a healthy lifestyle premium discount

• Tuition assistance

• Service Recognition

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.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Some states have required notifications. Here's more information.

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 minorities, females, disabled individuals and 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 physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail mycareer.help@bcbssc.com or call 1-800-288-2227, 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.