Case Manager - LPN

The Medicare Advantage Population Health Management group is looking for a Case Manager – LPN. This fully remote position plays an essential role in delivering high‑quality, coordinated care by supporting a collaborative Case Management team that includes Registered Nurses, Registered Dietitians, and Social Workers. In this role, you’ll provide both clinical and operational support through data collection, care coordination activities, provider and vendor communication, timely report distribution, and day‑to‑day assistance to team experts and leadership.

Working within a defined scope of practice and using established tools and protocols, you’ll support member outreach, referrals, appointment scheduling, and accurate documentation to ensure efficient, compliant care coordination. This is an ideal opportunity for an LPN who enjoys working in a structured, team‑based environment and is passionate about supporting members, providers, and interdisciplinary partners!

Preferred Qualifications:

• Understanding of Medicare Advantage programs
• Prior experience supporting or partnering with Case Managers
• Experience working with senior or aging populations
• Knowledge of Special Needs Plans, such as CSNP or DSNP
• Working knowledge of Microsoft Office applications (Excel, Teams, Outlook)

Job Responsibilities

• Initiate referrals and support care coordination workflows by gathering clinical, functional, and social information needed for RN led case assessment and service planning, following established case management procedures.
• Perform structured case management support activities (e.g., follow up calls, resource coordination, appointment scheduling, and preparation of case summaries) using predefined tools and templates, escalating any findings that require RN/Medical Director interpretation. The LPN does not exercise independent clinical judgment and does not make final determinations regarding medical necessity, service authorization, or adverse actions
• Consult with supervising RN or Medical Director when member needs, reported changes, or service issues involve clinical questions, exceptions, or situations requiring higher level clinical judgment, consistent with the LPN’s directed scope of practice. 
• Assist nonclinical staff by clarifying clinical documentation, verifying service needs within LPN scope, and ensuring complete and accurate case setup for RN/MD decision making.
• Apply approved care plan elements and benefit information to support monitoring and coordination activities, without independently assessing, developing, authorizing or modifying care plans or levels of care.
• Document all case management activities in required systems with accuracy, completeness, and adherence to regulatory case management documentation standards (e.g., NCQA/URAC/CMS). 
• Communicate with members, providers, caregivers, and internal teams regarding required documentation, service logistics, resource connections, and case status, using approved scripts and escalation pathways.
• Participate in quality improvement, compliance activities, and competency requirements tied to case management program standards.
• Various immunizations and/or associated medical tests may be required for this position.
• This job requires digital literacy assessment. 

Job Qualifications

License

• Licensed Practical Nurse (LPN) 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

• 1-2 years - Clinical experience required

Skills\Certifications

• Knowledge of community resources, benefits, and service authorization processes.
• Familiarity with care management frameworks and regulatory requirements.
• High attention to detail with the ability to document accurately and meet regulatory standards (NCQA, URAC, CMS).

This job description is not intended to expand the scope of practice of a Licensed Practical Nurse beyond applicable state licensure laws or to confer independent clinical authority reserved to Registered Nurses or physicians.

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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.