Job 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.Perform case management activities in community settings including face to face with members as required.Various immunizations and/or associated medical tests may be required for this position.Testing/Assessments will be required for Digital positions.

Job Qualifications

License

Current, active unrestricted Tennessee license in Nursing (RN) or behavioral health field (Master's level or above) (Ph.D., LCSW/LMSW, LLP, MHC, LPC, etc.) required. RN may hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law.

Experience

3 years - Clinical behavioral health / substance use disorder experience required1 year - Must be knowledgeable about community care resources and levels of behavioral health care available.

Skills\Certifications

Currently has a Certified Case Manager (CCM) credential or must obtain certification within 2 years of hire.Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)Independent, Sound decision-making and problem-solving skillsExcellent oral and written communication skillsStrong interpersonal and organizational skillsStrong analytical skillsPositive relationship building skills and ability to engage and motivate health behaviors in diverse populationsAbility to quickly identify and prioritize member needs and provide structured and focused support and interventionsExperience with Motivational Interviewing Techniques and Adult Learning Styles

Preferred Qualifications:

Experience in the Medical fieldSocial Work

Number of Openings Available:

1

Worker Type:

Employee

Company:

VSHP Volunteer State Health Plan, Inc

Applying for this job indicates your acknowledgement and understanding of the following statements:

BCBST is an Equal Opportunity employer (EEO), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made. BCBST will take affirmative action to recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

Tobacco-Free Hiring Statement

To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits. A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco/nicotine test.  An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotine  and/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results.

Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW.