Case Manager

🔥 12 hours ago

🌲 North Carolina – Remote

🌲 North Carolina – 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 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 • Perform comprehensive assessments and coordinate treatment, interventions, and discharge planning • Develop member-centric plans of care and identify barriers to goals • 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 • Potentially outreach to high-risk, high-cost, or high-utilization members • Potentially review alternative treatment plans, benefits exceptions, and flex benefit options • Potentially evaluate medical necessity and service appropriateness • 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) • For some roles, additional specialty certification (i.e. CCM, CDCES) may be required; relevant certification must be obtained within 2 years of employment if applicable • At this time, Blue Cross NC will not sponsor employment authorization for this position • Holding one or more additional non-compact state nursing licenses is strongly preferred • Broad clinical nursing experience across multiple care settings is highly desirable

🏖️ 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 • 401k match including an annual company contribution • Annual Incentive Bonus • Paid Time Off (PTO)