FEP Case Manager

🕒 3 days ago

🐎 Kentucky, North Carolina, +5 more states – Remote

🐎 Kentucky – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🦀 Maryland – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote ⚔️ Virginia – Remote

💵 $73.7k - $117.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Blue Cross NC

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1933

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Blue Cross NC is a health insurance provider that offers a range of health plans and services to individuals and groups. The company focuses on delivering quality healthcare coverage and improving health outcomes for its members through innovative health programs and services. Blue Cross NC is committed to enhancing access to affordable healthcare while supporting the health and wellness of the communities it serves.

📋 Description

• Coordinate appropriate care, resources, and/or services for selected member populations • Provide guidance and promote effective utilization and monitoring of health care resources • Collaborate with healthcare team members to achieve optimal clinical and resource outcomes • Serve on a multidisciplinary team coordinating care, resources, and services • Perform comprehensive assessments and collaborate on treatment, intervention, and discharge planning • Develop member-centric plans tailored to needs, health status, education, and support needs • Identify barriers to goals or plans of care • Utilize community resources and funding sources • Monitor and manage members through scheduled follow-up, education, referrals, documentation, progress assessment, and plan modification • Evaluate and facilitate care across the continuum, including physician offices, hospitals, rehabilitation units, skilled nursing facilities, and home care • Educate members and encourage proactive intervention • Document assessment, planning, implementation, monitoring, and outcomes • Outreach to high-risk, high-cost, or high-utilization members as needed • Review alternative treatment plans and assess benefits exceptions or flex benefit options • Evaluate medical necessity and appropriateness of services • Develop policies, procedures, education, or training as needed

🎯 Requirements

• RN with 3 years of clinical and/or case management experience required • Must have and maintain a valid and applicable clinical license (NC or compact multi-state licensure) • Must obtain Certified Case Manager (CCM) certification within 2 years of employment • Case Management experience strongly preferred • Telephonic case management experience strongly preferred • Certified Case Manager (CCM) certification preferred • EMR (electronic medical records) experience preferred • Strong technical aptitude and ability to learn new systems quickly

🏖️ Benefits

• Work-life balance, flexibility, and autonomy • Medical, dental, and vision coverage • Health and wellness programs • Parental leave and support • Adoption and surrogacy assistance • Career development programs • Tuition reimbursement for continued education • 401(k) match including an annual company contribution • Paid Time Off (PTO) • Annual Incentive Bonus based on annual corporate goal achievement and individual performance