Case Manager
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Job Description
Case Manager coordinating care plans, resources, and clinical outcomes for Blue Cross NC members. Working remotely across North Carolina, South Carolina, or Virginia with occasional office visits.
Responsibilities:
- Coordinate care, resources and/or services for selected member populations
- Provide guidance and promote effective utilization and monitoring of health care resources
- Collaborate with healthcare team members to achieve optimal clinical and resource outcomes
- Perform comprehensive assessments and coordinate with members, families, internal partners, and external providers
- Develop member-centric plans tailored to members’ needs, health status, education, and support needs
- Identify barriers to treatment goals or plans of care
- Utilize 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, including physician offices, hospitals, rehabilitation units, skilled nursing facilities, and home care
- Educate members and encourage proactive intervention
- Document assessments, care plans, implementation, monitoring, and outcomes
- Outreach to high-risk, high-cost, or high-utilization members as needed
- Review alternative treatment plans and assess benefits exceptions or flex benefit options as needed
- Evaluate medical necessity and service appropriateness
- 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)
- Additional specialty certification (e.g. CCM, CDCES) may be required for some roles; relevant certification must be obtained 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 continued education
- 401k match including an annual company contribution
- Paid Time Off (PTO)
- Annual Incentive Bonus
- Flexible work arrangements
- Work-life balance and autonomy
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