Provides care management services to more than 2 million members in South Carolina and nationally. Administers complex, high-touch concierge case management for members identified into specialized programs such as high-risk maternity, NICU, ESRD, Palliative Care Behavioral Health. Identifies risks and provides outreach services to facilitate the coordination of healthcare services and gap closure. Provides individualized care plans to ensure cost-effectiveness, overall care satisfaction, and improved quality of life.Description
65% Directs day-to-day, high-touch member management to include implementation of program goals, coordination of treatment plans, and benefits coordination for high-risk patient populations and/or those with complex conditions.
20% Coordinates clinical services with external sources to include: providers, vendors, facilities, social workers/case managers, and/or community services.
10% Participates in team training and continuing medical education.
5% Prepares for external audits and quality assurance efforts.
Required Work Experience:
Preferred Work Experience:
Required Skills and Abilities:
Preferred Skills and Abilities:
Required Software and Tools:
Preferred Software and Tools:
Required Licenses and Certificates:
Preferred Licenses and Certificates:
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.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 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 email@example.com or call 1-800-288-2227, ext. 43172 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.