BlueCross BlueShield of South Carolina · 6 hours ago
Intensive Care Management Coordinator
Columbia, SC
Full-time
Remote
Mid Level
3+ years exp
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Responsibilities
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.
Qualification
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Required
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.
Benefits
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
Company
BlueCross BlueShield of South Carolina
For more than six decades, BlueCross BlueShield of South Carolina has been part of the national landscape. Our roots are firmly embedded in the state.
10,001+ employees
Funding
Current Stage
Late StageLeadership Team
April Richardson
Vice President and Chief Operating Officer of Companion Benefit Alternative
Alli McGary
Talent Acquisition Partner
Recent News
Modern Healthcare
2024-11-05
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