Complex Case Manager

We are seeking a dedicated and experienced Case Manager to join our team.

This motivated nurse will be responsible for managing Complex members telephonically/ digitally with significant medical and psychosocial needs who require health teaching and to ensure timely, effective interventions and efficient use of benefits. In this role, you will apply sound clinical judgment to identify appropriate interventions, leverage multidisciplinary resources and referrals, and provide consistent follow-up to achieve optimal outcomes.

To succeed in this role, you will bring a proven ability to manage high volumes of work while maintaining exceptional attention to detail. You are comfortable balancing competing priorities, sustaining momentum, and remaining accountable for results over time. Strong digital and telephonic communication skills, solid technical proficiency, and high digital literacy are essential, along with an eagerness to leverage enterprise‑approved AI tools to enhance care delivery and improve workflow efficiency.

A clinical background in managing complex cases, with experience in areas such as Med‑Surg, ICU, Home Health, and/or Hospice strongly preferred. If this aligns with your experience and represents your next career step, we encourage you to apply.

Note:

• This is a remote role with working hours of Monday–Friday (8:00 a.m.–5:00 p.m.) eastern time or depending on time zone.

• Sponsorship is not available for this role.

• This position requires an 18-month commitment before applying for other internal roles, and certain immunizations or medical tests may be required.

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.
• Digital positions must have the ability to effectively communicate via digital channels and offer technical support.
• Effective 7/22/13: This Position requires an 18 month commitment before posting for other internal positions.
• Various immunizations and/or associated medical tests may be required for this position.
• This job requires digital literacy assessment.

Job Qualifications

License

• Registered Nurse (RN) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law.

Experience

• 3 years - Clinical experience required
• 5 years - Experience in the health care industry
• For Select Community & Katie Beckett: 2 years experience in IDD for Select Community is required

Skills\Certifications

• Excellent oral and written communication skills
• PC Skills required (Basic Microsoft Office and E-Mail)

Employees who are required to operate either a BCBST-owned vehicle or a personal or rental vehicle for company business on a routine basis* will be automatically enrolled into the BCBST Driver Safety Program. The employee will also be required to adhere to the guidelines set forth through the program. This includes, maintaining a valid driver’s license, auto insurance compliance with minimum liability requirements; as defined in the “Use of Non BCBST-Owned Vehicle” Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR).*The definition for "routine basis" is defined as daily, weekly or at regularly schedule times.

Number of Openings Available

1

Worker Type:

Employee

Company:

BCBST BlueCross BlueShield of Tennessee, Inc.

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

BCBST will 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.

Originally posted on Himalayas