Case Manager

🔥 16 hours ago

🌲 North Carolina, South Carolina, +1 more states – Remote

🌲 North Carolina – Remote 🌴 South Carolina – Remote ⚔️ Virginia – 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 tailored to needs, health status, education, and support requirements • Identify barriers to goals or plans of care and utilize community resources and funding sources • Monitor and manage members through follow-up, education, referrals, documentation, and plan modification • Evaluate and facilitate care across physician offices, hospitals, rehabilitation units, skilled nursing facilities, and home care • Educate members and encourage proactive intervention to limit expense and improve 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 • 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 (e.g. CCM, CDCES) may be required for some roles; if required, obtain it within 2 years of employment • One or more additional non-compact state nursing licenses strongly preferred • Broad clinical nursing experience across multiple care settings 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) • Work-life balance, flexibility, and autonomy • Remote work with a few in-office visits each year for meaningful moments