Case Manager

Blue Cross NC; United States; Hybrid; USD 74,000 - 118,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Parental leave

Tuition reimbursement

401k match

Paid PTO

Job summary

Blue Cross NC is hiring a Case Manager to join the Commercial Case Management team. The role coordinates care, resources and services for members, using clinical skills to assess and plan treatment, with focus on efficient utilization of health care resources and outcomes.

Responsibilities include collaborating with the health care team, developing member-centered plans, and monitoring progress. The position requires an RN with 3 years of clinical/case management experience and an active NC or

Qualifications

• RN with 3 years of clinical and/or case management experience.
• Active RN license in NC or compact multistate.
• For some roles, CCM or CDCES certification may be required; obtain within 2 years of employment.

Responsibilities

• Coordinate care, resources and services on a multidisciplinary team to achieve optimal outcomes.
• Perform comprehensive assessments to plan treatment, interventions, and discharge planning.
• Develop member-centric plans addressing needs, health status, and support levels; identify barriers.
• Utilize community resources and funding sources in the plan of care.
• Monitor and manage the member's progress, with appropriate follow-up and referrals.
• Evaluate care across the continuum and educate members for proactive care and cost management.

Skills

Care Plan Development

Care Planning

Clinical Outcomes

Health Care

Healthcare Utilization Management

Nursing Fundamentals

Patient Advocacy

Patient Care

Patient Care Coordination

Patient Evaluations

Education

RN license (NC or compact multistate)

Job description

Job Description

We’re hiring a Case Manager to join the Commercial Case Management team! Dependent on clinical discipline, the Case Manager / Health Coach coordinates appropriate care, resources and/or services of selected member populations. Provides guidance and promotes effective utilization and monitoring of health care resources to drive quality care for our members. Collaborates as needed with varied members of the healthcare team to achieve optimal clinical and/or resource outcomes. At Blue Cross NC, we’re making health care better for all – by listening deeply, challenging what’s possible, and putting care at the heart of everything we do. Join a purpose driven team where ideas spark change, growth is encouraged, collaboration fuels impact, and you’re supported with the flexibility and trust to do meaningful work.

What You’ll Do

• Serve as a team member on a multidisciplinary team, coordinating care, resources and/or services for members to achieve optimal clinical and resource outcomes.
• Utilize applicable clinical skillset and perform comprehensive assessments to determine how to best collaborate with members, family, internal partners and external services/providers on plans for treatment, appropriate intervention and/or discharge planning.
• Develop a member-centric plan tailored to members’ needs, health status, educational status and level of support needs; identify barriers to meeting goals or plan of care.
• Utilize community resources and funding sources as needed in the development of the plan of care.
• Perform ongoing monitoring and management of member which may include scheduled follow-up with member, discussion of plan with member, appropriate services/education to address needs, appropriate referrals with supporting documentation, assessment of progress towards goals, modification of plan/goals as needed, with contact frequency appropriate to member acuity.
• Evaluate and facilitate care provided to members through the continuum of care (physician office, hospital, rehabilitation unit, skilled nursing facility, home care, etc).
• Educate members and encourage pro-active intervention to limit expense and encourage positive outcomes
• Effectively document all aspects of the plan from the initial assessment, development of the plan, implementation, monitoring, and evaluating outcome.
• May outreach directly to members identified as high risk, high cost, or high utilization cases.
• May review alternative treatment plans for case management candidates and assess available benefits and the need for benefits exception or flex benefit options, where eligible.
• May evaluate medical necessity and appropriateness of services as defined by department.
• As needed, develop relevant policies/procedures, education or training for use both internally and externally.

What You Give

• 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) to perform described job duties.
• For some roles, additional specialty certification (i.e. CCM, CDCES) may be required. If so, incumbents must obtain relevant certification within 2 years of employment.

At this time, Blue Cross NC will not sponsor employment authorization for this position.

Bonus Points (Preferred Qualifications)

• Holding one or more additional non-compact state nursing licenses, in addition to the required Compact Multistate License, is strongly preferred.
• Broad clinical nursing experience across multiple care settings is highly desirable, including Medical-Surgical, Intensive Care Unit (ICU), Emergency Department, Pediatrics, Labor & Delivery, and other inpatient specialties.

What You’ll Get

• The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community
• Work-life balance, flexibility, and the autonomy to do great work
• Medical, dental, and vision coverage along with numerous health and wellness programs
• Parental leave and support plus adoption and surrogacy assistance
• Career development programs and tuition reimbursement for continued education
• 401k match including an annual company contribution
• Learn more

Where You’ll Work

Our Hybrid Flex approach is built on presence with a purpose – giving you flexibility to work remotely with intentional in-person connection – that supports a workplace that’s flexible, connected, and future focused. In a Hybrid-Flex role, you’ll work in the office at least two days a week for collaboration and connection. In a Remote Flex role, you’ll work virtually, with a few in-office visits each year for meaningful moments that matter. Whether your role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any states listed on this job posting. Onsite expectations will be discussed during the interview process.

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

• Based on annual corporate goal achievement and individual performance.

$73,698.00 - $117,917.00

Skills

Care Plan Development, Care Planning, Clinical Outcomes, Health Care, Healthcare Utilization Management, Nursing Fundamentals, Patient Advocacy, Patient Care, Patient Care Coordination, Patient Evaluations

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