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RN Medical Case Manager
BlueCross BlueShield of Tennessee. Provide comprehensive, member-centered care for individuals with complex and chronic conditions, including high-risk diagnoses .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in case management, including assessment, planning, and coordination of care for individuals with complex and chronic conditions. Proficient in utilizing digital communication tools and technical support to enhance member engagement and health outcomes.
Highest-signal resume keywords
Registered Nurse (RN) License3 Years Clinical Experience5 Years Healthcare Industry ExperienceCase Management ActivitiesDigital Literacy
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Case ManagementAssessmentPlanningImplementationMonitoringEvaluationUtilization ManagementComplex Needs AssessmentHealth Outcomes ImprovementCost-Effective Service Utilization
Soft Skills
Excellent Oral CommunicationExcellent Written CommunicationMember EngagementAdvocacy-Driven ApproachCollaboration
Tools & Technologies
Microsoft OfficeEmailDigital Communication ToolsAI ToolsTelephonic Communication
Certifications & Qualifications
Active RN License in TennesseeNurse Licensure Compact Law Eligibility
Industry Keywords
Chronic ConditionsHigh-Risk DiagnosesIDD ExperienceHealthcare DeliveryMember-Centered Care
About the role
Key responsibilities & impact- Provide comprehensive, member-centered care for individuals with complex and chronic conditions, including high-risk diagnoses
- Use a proactive, advocacy-driven approach to support members
- Collaborate across multidisciplinary teams to coordinate care, reduce barriers, and improve health outcomes
- Support cost-effective utilization of services and reduce unnecessary ED and inpatient utilization
- Manage a dynamic caseload
- Support utilization management functions for more complex and non-routine cases as needed
- Serve as a liaison between members, providers, and internal/external customers in coordinating healthcare delivery and benefits programs
- Oversee highly complex cases to ensure effective implementation of interventions and efficient utilization of benefits
- Perform case management activities including assessment, planning, implementation, coordinating, monitoring, outcomes, and evaluation
- Communicate via digital channels and offer technical support
Requirements
What you’ll need- 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
- 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
- Excellent oral and written communication skills
- PC skills required (Basic Microsoft Office and E-Mail)
- Strong technical proficiency
- Ability to effectively communicate via digital channels and offer technical support
- Ability to assess and manage complex needs in a telephonic and digital environment
- Ability to navigate care across the continuum
- Ability to effectively engage members to drive adherence and outcomes
- Willingness to leverage enterprise-approved digital and AI tools
- Digital literacy assessment required
- Various immunizations and/or associated medical tests may be required
Benefits
Comp & perks- Employee position
- Various immunizations and/or associated medical tests may be required for this position