Episodic Care Manager

🔥 0 minutes 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.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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

• Perform clinical reviews to assess, facilitate, and coordinate delivery of health care services based on medical necessity and contractual benefits • Coordinate with providers, members, and internal staff to support high-quality, cost-effective care • Receive assigned cases for inpatient, outpatient, DME, and other member services • Review and evaluate cases against medical policy, benefits, care guidelines, and regulations • Complete work according to timeliness, production, clinical quality/accuracy, and compliance standards • Provide notifications to members and/or providers according to regulatory requirements • Assess cases for secondary review by the Medical Director for denials and coordinate as needed • Coordinate peer-to-peer reviews upon provider request when members’ conditions do not meet guidelines • Communicate and collaborate with internal and external clinical and non-clinical staff, including Medical Directors • Document review outcomes fully and accurately • Interpret and analyze clinical information • Summarize clinical reviews against criteria and guidelines to provide necessary information for Medical Directors

🎯 Requirements

• RN with 3 years of clinical experience or LPN with 5 years of clinical experience • For Behavioral Health specific roles, other applicable licensure may be considered with a minimum of 3 years of clinical experience • Must have and maintain a valid and applicable clinical license (NC or compact multi-state licensure) • Recent hands-on bedside nursing experience in an acute care hospital setting required • Experience may include Medical-Surgical, ICU, Emergency Department, Pediatrics, Labor & Delivery, or other inpatient specialties • Direct patient care experience • Strong understanding of clinical diagnoses and treatment plans • Ability to interpret medical documentation • Clinical knowledge of medical necessity, medical policy, benefits, care guidelines, and regulations • Ability to meet timeliness, production, clinical quality/accuracy, and compliance standards

🏖️ 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 based on annual corporate goal achievement and individual performance • Paid Time Off (PTO) • Competitive health benefits and wellness programs • Remote work with a few in-office visits each year for Remote Flex roles