RN Medical Case Manager

The High-Cost Claim team at BCBST is seeking a compassionate and highly skilled RN Case Manager to support members with advanced and multifaceted healthcare needs.

In this role, you will provide comprehensive, member-centered care for individuals with complex and chronic conditions, including high-risk diagnoses, through a proactive, advocacy-driven approach. You will collaborate across multidisciplinary teams to coordinate care, reduce barriers, and improve health outcomes while supporting cost-effective utilization of services and reducing unnecessary ED and inpatient utilization.

Success in this position requires the ability to manage a dynamic caseload with strong critical thinking, attention to detail, and exceptional telephonic and digital communication skills.

The ideal candidate brings a strong clinical foundation combined with care coordination expertise, including:

• Experience in acute care settings such as ED, ICU, or Med-Surg
• Background in case management, transitions of care, or discharge planning
• Experience supporting members with complex needs is highly valued, including: Chronic conditions (e.g., CHF, COPD, diabetes)
• Behavioral health needs
• Home and community-based care
• This experience strengthens the ability to develop effective discharge plans and prevent avoidable readmissions.
• Candidates should also demonstrate the ability to: Assess and manage complex needs in a telephonic and digital environment
• Navigate care across the continuum
• Effectively engage members to drive adherence and outcomes
• Strong technical proficiency is essential, along with a willingness to leverage enterprise-approved digital and AI tools to enhance care delivery, documentation, and operational efficiency.
• 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)
• N/A 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 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.