Case Manager

This is a fully remote position, open to applicants in North Carolina.

📋 Description

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

• Offer guidance and promote the effective use and monitoring of healthcare resources

• Collaborate with healthcare team members to achieve optimal clinical and resource outcomes

• Conduct comprehensive assessments and coordinate treatment, interventions, and discharge planning

• Create member-centric care plans and identify barriers to achieving goals

• Leverage community resources and funding sources

• Monitor and manage members through follow-up, education, referrals, documentation, and plan modifications

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

• Educate members and promote proactive interventions

• Document assessments, plans, implementations, monitoring, and outcomes

• Potentially reach out to high-risk, high-cost, or high-utilization members

• Potentially review alternative treatment plans, benefits exceptions, and flexible benefit options

• Potentially assess medical necessity and service appropriateness

• Develop policies, procedures, educational materials, or training as necessary

⛳️ 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)

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

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

• Holding one or more additional non-compact state nursing licenses is highly preferred

• Extensive clinical nursing experience across various care settings is greatly desirable

🏝️ 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

• 401k match along with an annual company contribution

• Annual Incentive Bonus

• Paid Time Off (PTO)