Case Manager
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Job Description
Case Manager coordinating Medicare care, resources, and services for Blue Cross NC members. Assessing needs, managing care plans, and supporting better health outcomes across the care continuum.
Responsibilities:
- Coordinate care, resources, and services for selected member populations
- Serve on a multidisciplinary team to achieve optimal clinical and resource outcomes
- Perform comprehensive assessments and collaborate on treatment, intervention, and discharge planning
- Develop member-centric plans tailored to needs, health status, education, and support levels
- Identify barriers to meeting care-plan goals
- Use community resources and funding sources in care-plan development
- Monitor and manage members through follow-ups, education, referrals, progress assessments, 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 improve outcomes
- Document assessments, care plans, implementation, monitoring, and outcomes
- Outreach to high-risk, high-cost, or high-utilization members
- Review alternative treatment plans, benefits, exceptions, and flex-benefit options
- Evaluate medical necessity and service appropriateness
- Develop policies, procedures, education, or training as needed
Requirements:
- RN, RD, or LCSW with 3 years of clinical and/or case management experience required
- For some roles, a Master’s in Social Work with 5 years of related experience may be considered
- Behavioral Health roles may accept other applicable licensure with at least 3 years of clinical experience
- Must have and maintain a valid, applicable clinical license in North Carolina or compact multi-state licensure
- Additional specialty certification, such as CCM or CDCES, may be required for some roles
- Required specialty certifications must be obtained within 2 years of employment when applicable
- Active RN license preferred
- Prior hospital care experience strongly preferred
- Proficiency with computers and Microsoft Office applications
- Strong technical aptitude and ability to learn new systems quickly
- Certified Case Manager (CCM) certification preferred
- Authorization to work in the United States
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
- Paid Time Off (PTO)
- Competitive health benefits and wellness programs
- Reasonable accommodations for applicants with disabilities
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