Case Manager

This is a fully remote position, open to applicants in North Carolina, +2 more states.

📋 Description

• Oversee care, resources, and/or services for designated member populations

• Offer guidance and foster efficient utilization and monitoring of healthcare resources

• Collaborate with members of the healthcare team to attain optimal clinical and resource outcomes

• Conduct thorough assessments and coordinate with members, families, internal partners, and external providers

• Create member-focused plans customized to individual needs, health conditions, education, and support requirements

• Identify obstacles to treatment goals or care plans

• Leverage community resources and funding options

• Monitor and manage members through follow-up, education, referrals, documentation, and adjustments to plans

• Evaluate and facilitate care across the healthcare continuum, including physician offices, hospitals, rehabilitation units, skilled nursing facilities, and home care

• Educate members and promote proactive interventions

• Record assessments, care plans, implementations, monitoring, and outcomes

• Reach out to high-risk, high-cost, or high-utilization members as necessary

• Review alternative treatment plans and evaluate benefits exceptions or flexible benefit options as needed

• Assess medical necessity and appropriateness of services

• Develop policies, procedures, education, or training as required

⛳️ Requirements

• RN with a minimum of 3 years of clinical and/or case management experience required

• Must possess and maintain a valid and applicable clinical license (NC or compact multi-state licensure)

• Additional specialty certification (e.g., CCM, CDCES) may be necessary for certain roles; relevant certification must be acquired within 2 years of employment if required

• Blue Cross NC will not sponsor employment authorization for this position

🏝️ Benefits

• Medical, dental, and vision coverage

• Health and wellness programs

• Parental leave and support

• Adoption and surrogacy assistance

• Career development programs

• Tuition reimbursement for ongoing education

• 401k match including an annual company contribution

• Paid Time Off (PTO)

• Annual Incentive Bonus

• Flexible work arrangements

• Work-life balance and autonomy