RN Case Management Coordinator

RN Case Management Coordinator at BlueCross BlueShield of South Carolina. The role focuses on active care management, assessing service needs, developing and coordinating action plans with members, monitoring services, and ensuring medical necessity criteria and contract benefits are met. Responsibilities include telephonic support for members with chronic conditions or high-risk situations, member-centered coaching using motivational interviewing, patient education with providers about the health care delivery system and benefit plans, enrollment in care management programs, documentation and data entry for clinical information flow and claims adjudication, and ensuring compliance with regulatory bodies (ERISA, NCQA, URAC, DOL). The position requires an active RN license (US state of hire or compact) and is remote within South Carolina with a typical 40-hour workweek, Monday–Friday, 8:00am–5:00pm EST. Educational preference includes an Associate’s degree with relevant clinical experience; preferred certifications in case management.