Summary
We are currently hiring for an Intensive Care Management Coordinator to join BlueCross BlueShield of South Carolina. In this role as an Intensive Care Management Coordinator, you will serve as an Intensive Case Manager (ICM) for members identified with specific conditions and assist with implementation of case management activities/programs for BlueCross BlueShield of South Carolina (BCBSSC), BlueChoice and/or Healthy Blue Medicaid members.
Our ideal candidate will possess the following experience
- Four years of recent clinical experience in a defined Behavioral Health specialty area. Specialty areas include: Serious Mental Illness (SMI), Trauma and Post-Traumatic Stress Disorder, Substance Use Disorders (SUD), Child and Adolescent Behavioral Health, and Cognitive Disorders. Or, 4 years of Behavioral Health utilization review/case management/clinical/or combination; 2 of the 4 years must be clinical.
Location
This position is full-time (40 hours/week) Monday-Friday from 8:30am-5:00pm EST and will be fully remote. This position will require the candidate to spend most of their time traveling within a South Carolina region to conduct member-facing patient visits. This position offers mileage reimbursement after mile 50 with a reimbursement rate of 70 cents per mile, and a travel limit of 3-hours one way.
Our ideal candidate must reside in Low-Country Region of South Carolina, preferably Beaufort County.
What You Will Do
- 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.
To Qualify for This Position, You Will Need
- Required Education: 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.
- Degree Equivalency: 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.
- Required Work Experience: 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.
- Required Skills and Abilities: 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.
- Required Software and Tools: Microsoft Office.
- Required Licenses and Certificates: 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.
What We Prefer You To Have
- Must have experience of working directly with individuals with mental illnesses.