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Medical Case Manager

BlueCross BlueShield of Tennessee
Full-time
Remote
United States
Case Management Care Management, Registered Nurse RN, Utilization Management Utilization Review, Entry Level, Triage Telehealth, Women's Health

BlueCross BlueShield of Tennessee seeks an experienced Registered Nurse to provide compassionate, member-centered care for women navigating a wide range of women’s health needs, from pregnancy through perimenopause.

This role leverages telephonic nursing and digital care delivery to educate, support, and coordinate care for members, ensuring timely, personalized, and whole-person support across the continuum of care.

In this role, you will:

  • Conduct comprehensive telephonic assessments to identify member needs and create individualized care plans
  • Provide education, coaching, and emotional support through some of life’s most complex health transitions
  • Deliver ongoing telephonic nursing support and care management to promote engagement and adherence
  • Coordinate care with OB/GYNs, primary care providers, behavioral health specialists, and other partners
  • Monitor member progress, adjust care plans as needed, and advocate for appropriate access to care

You will be an ideal candidate for this role if you:

  • Are passionate about women’s health and experienced in building trust through telephonic nursing or case management
  • Have 3+ years of experience in women’s healthcare, maternity, GYN, women’s health, care management, or telephonic nursing
  • Bring experience supporting members remotely through education, care coordination, and longitudinal case management
  • Are tech-savvy, adaptable, and comfortable working in a remote, virtual care environment
  • Demonstrate excellent communication, empathy, and problem-solving skills
  • Value continuous program improvement and contributing to evolving care models
  • Have excitement around (and experience leveraging) approved AI tools (e.g., Copilot) to drive efficiencies, streamline workflows, and support high‑quality outcomes

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:

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.