Case Manager

🔥 5 minutes ago

🏈 Alabama, Arizona, +23 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote ⛰️ Colorado – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🦀 Maryland – Remote 🚗 Michigan – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote ⚔️ Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $73.7k - $117.9k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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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 • Serve on a multidisciplinary team to achieve optimal clinical and resource outcomes • Perform comprehensive assessments and collaborate on treatment, intervention, and discharge planning • Develop member-centric plans tailored to needs, health status, education, and support levels • Identify barriers to meeting care-plan goals • Use community resources and funding sources in care-plan development • Monitor and manage members through follow-ups, education, referrals, progress assessments, 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 improve outcomes • Document assessments, care plans, implementation, monitoring, and outcomes • Outreach to high-risk, high-cost, or high-utilization members • Review alternative treatment plans, benefits, exceptions, and flex-benefit options • Evaluate medical necessity and service appropriateness • Develop policies, procedures, education, or training as needed

🎯 Requirements

• RN, RD, or LCSW with 3 years of clinical and/or case management experience required • For some roles, a Master’s in Social Work with 5 years of related experience may be considered • Behavioral Health roles may accept other applicable licensure with at least 3 years of clinical experience • Must have and maintain a valid, applicable clinical license in North Carolina or compact multi-state licensure • Additional specialty certification, such as CCM or CDCES, may be required for some roles • Required specialty certifications must be obtained within 2 years of employment when applicable • Active RN license preferred • Prior hospital care experience strongly preferred • Proficiency with computers and Microsoft Office applications • Strong technical aptitude and ability to learn new systems quickly • Certified Case Manager (CCM) certification preferred • Authorization to work in the United States

🏖️ 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 • Annual Incentive Bonus • Paid Time Off (PTO) • Competitive health benefits and wellness programs • Reasonable accommodations for applicants with disabilities