BlueCross BlueShield of South Carolina · 5 hours ago
Intensive Care Management Coordinator
South Carolina, United States
Full-time
Hybrid
Mid Level
3+ years expBlueCross BlueShield of South Carolina is currently hiring for an Intensive Care Management Coordinator. In this role, you will serve as an Intensive Case Manager for members identified with specific conditions, assisting with the implementation of case management activities and programs for various Medicaid members.
Financial ServicesHealth CareHealth InsuranceInsuranceMedical
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, 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 updates of 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 documents information appropriately
Assist with development of strategies to increase 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
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: 4-year degree in nursing, psychology, social work, early childhood education, child development or a related field with minimum of 45 documented training hours related to specialty area issues and treatment
If Maternal Health Intensive Case Manager: 4-year degree in Health Promotion or related field OR 2-year degree and 2 years' experience in healthcare environment or as a Certified Childbirth Educator/Prenatal Educator, OR graduate of an approved LPN program and 2 years' experience in maternity management healthcare environment
If Medical Health Intensive Case Manager: 4-year degree in Health Promotion, Exercise Science, or related field or Certified Asthma Educator or RRT (Registered Respiratory Therapist)
If Master's, 1 year experience may also be in Exercise Science, Nutrition, Physical Therapy, or other health-related degrees. If Wellness Coach/Health Promotion: 4-year degree in Health Administration, Health Promotion, Exercise Science, Education/Training, or health-related field
At least 3 years' experience working with people with specified health conditions
If master's degree, 2 years' experience working with people with specified health condition
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 evidenced 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 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
Preferred
Must have experience of working directly with individuals with mental illnesses
Benefits
Subsidized health plans, dental and vision coverage
401k retirement savings plan with company match
Life Insurance
Paid Time Off (PTO)
On-site cafeterias and fitness centers in major locations
Education Assistance
Service Recognition
National discounts to movies, theaters, zoos, theme parks and more
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.
10001+ 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
2025-09-13
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