Case Manager
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Job Description
RN Case Manager coordinating member care, assessments, and utilization for Blue Cross NC. Working remotely in North Carolina with occasional in-office visits.
Responsibilities:
- Coordinate care, resources, and/or services for selected member populations
- Serve on a multidisciplinary team to achieve optimal clinical and resource outcomes
- Perform comprehensive assessments and develop member-centric treatment, intervention, and discharge plans
- Identify barriers to meeting care goals and utilize community resources and funding sources
- Monitor and manage members through scheduled follow-ups, education, referrals, documentation, 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 promote positive 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 as needed
- 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)
- For some roles, additional specialty certification (i.e. CCM, CDCES) may be required; relevant certification must be obtained within 2 years of employment if required
- Additional non-compact state nursing licenses are strongly preferred
- Broad clinical nursing experience across multiple care settings is 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)
- Flexible work arrangements
- Work-life balance and autonomy
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