BlueCross BlueShield of Tennessee

Compensation

Full Description

About the position Responsibilities • Supporting utilization management functions for more complex and non-routine cases as needed. • Serving as a liaison between members, providers and internal/external customers in coordination of health care delivery and benefits programs. • Overseeing highly complex cases identified through various mechanisms to ensure effective implementation of interventions, and to ensure efficient utilization of benefits • Performing the essential activities of case management: assessment: planning, implementation, coordinating, monitoring, outcomes and evaluation. • Digital positions must have the ability to effectively communicate via digital channels and offer technical support. Requirements • Registered Nurse (RN) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law. • 3 years - Clinical experience required • 5 years - Experience in the health care industry • For Select Community & Katie Beckett: 2 years experience in IDD for Select Community is required • Currently has a Certified Case Manager (CCM) credential or must obtain certification within 2 years of hire. • For Select Community & Katie Beckett: In addition to CCM, Certification in Developmental Disabilities Nursing (CDDN) is required at hire, or must be attained within 3 years. • Excellent oral and written communication skills • PC Skills required (Basic Microsoft Office and E-Mail) • Employees who are required to operate either a BCBST-owned vehicle or a personal or rental vehicle for company business on a routine basis will be automatically enrolled into the BCBST Driver Safety Program. The employee will also be required to adhere to the guidelines set forth through the program. This includes, maintaining a valid driver’s license, auto insurance compliance with minimum liability requirements; as defined in the “Use of Non BCBST-Owned Vehicle” Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR). The definition for "routine basis" is defined as daily, weekly or at regularly schedule times.