Managed Care Coordinator II/BH-CM

3 weeks ago


Charleston, West Virginia, United States BlueCross BlueShield of South Carolina Full time
Job Summary

We are seeking a highly skilled RN Managed Care Coordinator II/BH-CM to join our team at BlueCross BlueShield of South Carolina. In this role, you will be responsible for providing care management interventions to improve care coordination and reduce fragmentation of services. You will work closely with members, healthcare providers, and other stakeholders to ensure seamless care delivery.

Key Responsibilities
  • Assess service needs and develop action plans in cooperation with members
  • Monitor services and implement plans to ensure member goals are met
  • Evaluate outcomes of plans and ensure medical necessity criteria are met
  • Provide telephonic support for members with chronic conditions or high-risk pregnancy
  • Participate in direct intervention/patient education with members and providers
Requirements
  • Associates in a job-related field or Graduate of Accredited School of Nursing
  • Two years job-related work experience or four years recent clinical experience in a defined specialty area
  • Working knowledge of word processing software and quality improvement processes
  • Ability to work independently, prioritize effectively, and make sound decisions
What We Offer
  • 401(k) retirement savings plan with company match
  • Subsidized health plans and free vision coverage
  • Life insurance and paid annual leave
  • On-site cafeterias and fitness centers in major locations
  • Wellness programs and healthy lifestyle premium discount


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