Case Manager

🔥 1 minute ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $73.7k - $117.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 0%

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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 care, resources, and 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 • Perform comprehensive assessments and coordinate treatment, interventions, and discharge planning • Develop member-centric plans based on needs, health status, education, and support requirements • Identify barriers to goals and plans of care • Utilize community resources and funding sources • Monitor and manage members through follow-up, education, referrals, documentation, and plan modifications • 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 assessments, plans, implementation, monitoring, and outcomes • Outreach to high-risk, high-cost, or high-utilization members when 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) • Additional specialty certification may be required for some roles, such as CCM or CDCES; relevant certification must be obtained within 2 years of employment if required • At this time, Blue Cross NC will not sponsor employment authorization for this position • Additional non-compact state nursing licenses are strongly preferred • Broad clinical nursing experience across multiple care settings is highly desirable • Skills: Care Plan Development, Care Planning, Clinical Outcomes, Health Care, Healthcare Utilization Management, Nursing Fundamentals, Patient Advocacy, Patient Care, Patient Care Coordination, Patient Evaluations

🏖️ Benefits

• 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 • 401k match including an annual company contribution • Paid Time Off (PTO) • Annual Incentive Bonus • Flexible work arrangements • Work-life balance and autonomy