Case Manager

🔥 14 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 • Serve on a multidisciplinary team to achieve optimal clinical and resource outcomes • Perform comprehensive assessments and develop member-centric treatment, intervention, and discharge plans • Identify barriers to meeting care goals and utilize community resources and funding sources • Monitor and manage members through scheduled follow-ups, 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 to limit expense and promote positive outcomes • Document assessment, planning, implementation, monitoring, and outcomes • Outreach to high-risk, high-cost, or high-utilization members as needed • Review alternative treatment plans, benefits, exceptions, and flex benefit options as needed • 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) • For some roles, additional specialty certification (i.e. CCM, CDCES) may be required; relevant certification must be obtained within 2 years of employment if required • Additional non-compact state nursing licenses are strongly preferred • Broad clinical nursing experience across multiple care settings is highly desirable, including Medical-Surgical, ICU, Emergency Department, Pediatrics, Labor & Delivery, and other inpatient specialties

🏖️ 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 • Annual Incentive Bonus • Paid Time Off (PTO) • Flexible work arrangements • Work-life balance and autonomy