Remote Utilization Review Rn Jobs in Rhode Island

Summary
 We are currently hiring for an RN Concierge Care Manager to join BlueCross BlueShield of South Carolina. In this role as an RN Concierge Care Manager, you will provide care management services to more than 2 million members in South Carolina and nationally, administer complex, high-touch concierge case management for members identified into specialized programs such as high-risk maternity, NICU, ESRD, Cancer, Palliative Care or Behavioral Health, identify risks and provides outreach services to facilitate the coordination of healthcare services and gap closure, and provide individualized care plans to ensure cost-effectiveness, overall care satisfaction, and improved quality of life.
Description
 

Location

This position is full-time (40 hours/week) Monday-Friday from 8:00am-5:00pm EST and will be fully remote. To work from home, the candidate must have high-speed (non-satellite) internet and a private, secure home office.

The position will be fully remote on a desktop computer to provide highly interactive case management to assigned members. Members will include those with chronic or high-risk conditions and those who are admitted to inpatient care. You will educate and guide members through prior authorizations and understanding the need to adhere to medications and the plan of care. Most interactions will be by phone and through our messaging system, perfect for those who love case management and improving the lives and medical outcomes of members while working in your own home office.

To aid in your consideration, please attach a copy of your current RN license, or include your RN license number on your resume.

What You'll Do:

• Directs day-to-day, high-touch member management to include implementation of program goals, coordination of treatment plans and benefit coordination for high-risk patient populations and/or those with complex conditions.

• Coordinates clinical services with external sources to include: providers, vendors, facilities, social workers/case managers and/or community services.

• Participates in team training and continuing medical education.

• Prepares for external audits and quality assurance efforts.

To Qualify for This Position, You'll Need the Following:

• Required Education: Associate's degree in nursing OR Graduate of Accredited School of Nursing OR master's degree in social work, Psychology, or Counseling.

• Required Work Experience: 5 years' case management experience or 2 years' case manager experience in a health insurance environment.

• Required Skills and Abilities: Working knowledge of word processing software.

• Knowledge of quality improvement processes and demonstrated ability with these activities.

• Knowledge of contract language and application.

• Ability to work independently, prioritize effectively, and make sound decisions.

• Demonstrated customer service, organizational, and presentation skills.

• Demonstrated proficiency in spelling, punctuation, and grammar skills.

• Demonstrated oral and written communication skills.

• Ability to persuade, negotiate, or influence others.

• Analytical or creative thinking skills.

• Ability to handle confidential or sensitive information with discretion.

• Required Software and Tools: Microsoft Office

• Required Licenses and Certificates: 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); OR active licensure as a social worker, psychologist, or counselor in state of hire. Nationally recognized Case Management certification to be obtained within 2 years of hire as a Case Manager.

We Prefer That You Have the Following:

• Preferred Education: Bachelor's degree in health-related field (Nursing, Healthcare Administration, Pharmacy, Sciences, Applied Health)

• Preferred Work Experience: 5 years' experience in Maternity/ NICU.

• Preferred Skills and Abilities: Strong communication and customer services skills.

• Excellent analytical skills to problem solve and remedy issues immediately.

• Ability to work in an autonomous environment or leadership capacity.

• Preferred Software and Tools: Working knowledge of Microsoft Word, PowerPoint, Excel, or other spreadsheet/database software; TMCS, LiveOps, MDDS, and BlueVue.

• Preferred Licenses and Certificates: Case manager certification, clinical certification in specialty area. Basic Life Support (BLS) or Advanced Cardiac Life Support (ACLS) certification.

Our Comprehensive Benefits Package Includes the Following:

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits for the first of the month following 28 days of employment.

• 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

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

What To Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will conduct interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.

Pay Range Information:

Range Minimum

$57,790.00

Range Midpoint

$84,089.00

Range Maximum

$110,388.00

Pay Transparency Statement:

Please note that this range represents the pay range for this and other positions that fall into this pay grade. Compensation decisions within the range will be dependent upon a variety of factors, including experience, geographic location, and internal equity.

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 individuals with disabilitiesand protected 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 disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.comor call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's moreinformation.

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