RN Concierge Care Manager – Medical Case Management

BlueCross BlueShield of South Carolina

. Direct day-to-day, high-touch member management, including implementation of program goals, coordination of treatment plans, and benefit coordination for high-risk patient populations and/or members with complex conditions .

Posted 11/5/2026full-timeRemote • South Carolina • United StatesJuniorMid-Level💰 $57,790 - $110,388 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in case management for high-risk patient populations, including the development of individualized care plans and coordination of clinical services. Proficient in managing member interactions and ensuring compliance with quality improvement processes while maintaining confidentiality.

Highest-signal resume keywords

Active RN LicensureCase Management ExperienceQuality Improvement ProcessesMicrosoft Office ProficiencyNationally Recognized Case Management Certification

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Case ManagementIndividualized Care PlansHealthcare CoordinationRisk IdentificationPrior Authorization Guidance

Soft Skills

Customer ServiceOrganizational SkillsOral CommunicationWritten CommunicationAnalytical Thinking

Tools & Technologies

Microsoft WordMicrosoft PowerPointMicrosoft ExcelTMCSLiveOpsMDDSBlueVue

Certifications & Qualifications

Nationally Recognized Case Management CertificationBLS CertificationACLS Certification

Industry Keywords

High-Risk Patient PopulationsComplex ConditionsConcierge Case ManagementBehavioral HealthPalliative Care

About the role

Key responsibilities & impact

Direct day-to-day, high-touch member management, including implementation of program goals, coordination of treatment plans, and benefit coordination for high-risk patient populations and/or members with complex conditions
Coordinate clinical services with providers, vendors, facilities, social workers/case managers, and community services
Participate in team training and continuing medical education
Prepare for external audits and quality assurance efforts
Provide concierge case management for members in specialized programs such as high-risk maternity, NICU, ESRD, Cancer, Palliative Care, or Behavioral Health
Identify risks and provide outreach to coordinate healthcare services and close care gaps
Create individualized care plans supporting cost-effectiveness, care satisfaction, and improved quality of life
Educate and guide members through prior authorizations, medication adherence, and their plan of care
Manage interactions primarily by phone and messaging system for members with chronic, high-risk, or inpatient conditions

Requirements

What you’ll need

Associate’s degree in nursing OR Graduate of Accredited School of Nursing OR master’s degree in social work, Psychology, or Counseling
5 years' case management experience as an RN OR 2 years’ case manager experience as an RN in a health insurance environment
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
Microsoft Office
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
Preferred: Bachelor's degree in health-related field
Preferred: 5 years’ experience in case management in a sub-specialty area
Preferred: Working knowledge of Microsoft Word, PowerPoint, Excel, or other spreadsheet/database software; TMCS, LiveOps, MDDS, and BlueVue
Preferred: Case manager certification, clinical certification in specialty area, BLS or ACLS certification

Benefits

Comp & perks

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