Financial Forecasting Registered Nurse I

Job Description:

Summary

We are currently hiring for a Financial Forecasting Registered Nurse I to join BlueCross BlueShield of South Carolina. In this role as a Financial Forecasting Registered Nurse I, you will perform clinical investigation of potential high-cost claimants and perform Excess Loss Medical Assessment and High Dollar Forecast as needed. Provides support to underwriting, actuarial, and external customers in the form of monitoring and predicting ultimate losses for potential future high-cost claimants. Supports cost containment through early identification and referrals to appropriate care management staff. Notifies appropriate unit and provides educational assistance when findings indicate need for further research and correction.

Description

Location:

This position is full-time (40-hours/week) Monday-Friday from 8:00am-4:30pm and will be fully remote. Our ideal candidate must reside in SC.

What You’ll Do:

• Performs clinical investigation of potential high-cost claimants to include research of historical claims and current outlook status. Performs Excess Loss Medical Assessment and High Dollar Forecast as needed. Makes decisions regarding estimated length of episode using nursing knowledge of disease process as well as reference tools.
• Provides support to underwriting, actuarial, and external customers via completion of formal reporting of potential high-cost claimants, which includes clinical summary as well as ultimate financial impact projections. Accuracy of estimate range is audited and expected.
• Supports cost containment through early identification and referrals to appropriate care management staff (Medical Director, Case/Disease Management, Quality of Care Referrals, etc.).
• Notifies appropriate units and provides educational assistance when findings indicate need for further research and correction (example: claims processing issues).

To Qualify for This Position, You'll Need the Following:

• Required Education:  Associates in a job related field
• Degree Equivalency: Graduate of Accredited School of Nursing
• Required Work Experience: 6 years’ clinical experience. 4 years clinical experience if bachelor’s degree in nursing.
• Required Skills and Abilities: Strong written communication and critical thinking skills.
• Ability to perform in-depth research and apply analytical and mathematical skills.
• Familiarity with the continuum of care as well as a wide range of costly episodes in the healthcare system.
• Working knowledge of word processing software.
• Ability to work independently, prioritize effectively, and make sound decisions.
• Good judgment skills.
• Demonstrated customer service, organizational, and presentation skills.
• Ability to persuade, negotiate, or influence others.
• Ability to handle confidential or sensitive information with discretion.
• Required Software and Tools: Microsoft Office.
• Required Licenses and Certificates: 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).

What We Prefer You To Have:

• Preferred Education: Bachelor's degree in Nursing.
• Preferred Work Experience: 4 years' healthcare program management.
• Preferred Skills and Abilities: Working knowledge of managed care and various forms of health care delivery systems. Working knowledge of catastrophic claims cost, medical vendors, case management.
• Preferred Software and Tools: Working knowledge of Microsoft Access, or other spreadsheet/database software

Our Comprehensive Benefits Package Includes the Following:

We offer our employees great benefits and rewards.  You will be eligible to participate in the benefits the first of the month following 28 days of employment.  

• 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

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

What To Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.

Some states have required notifications. Here's more information. 

Talent Community

If you don’t have an account with us and don’t see the dream job you are looking for, click on the link above to Join Our Talent Community by submitting your resume and contact information and we will reach out if we find a good fit.

About Us

Welcome

Here’s Your Smart Career Move

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. Business and political climates may change, but we’re stronger than ever. Our A.M. Best rating is A+ (Superior) — making us the only health insurance company in South Carolina with that rating.

We’re the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Veterans Welcome!

BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We’ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more. 

Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson. 

If you are a full-time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty. 

Join Us

If you're ready to join in a diverse company with secure, community roots and an innovative future, apply for a position now!