FEP Case Manager

Blue Cross and Blue Shield of North Carolina; South Carolina; Hybrid; USD 74,000 - 118,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

401k match

Paid Time Off (PTO)

Tuition reimbursement

Parental leave and adoption/surrogacy支

Job summary

Blue Cross NC is seeking a skilled Case Manager to join the FEP Case Management Team. An RN with clinical expertise coordinates care, resources and services to improve outcomes for members and ensure appropriate utilization of health care resources.

You will assess, plan, implement and monitor member plans, collaborate with the care team, educate members, document progress, and address barriers. Hybrid/Remote Flex work with strong benefits and a supportive professional environment.

Qualifications

• RN license to practice in NC or compact state required.
• 3 years of clinical and/or case management experience required.
• Incumbent must obtain CCM certification within 2 years of employment.

Responsibilities

• Coordinate care, resources and services for members to achieve optimal outcomes.
• Perform comprehensive assessments to plan treatment, intervention and discharge planning.
• Develop member-centric care plans addressing needs, status and support levels.
• Utilize community resources to support care plans and address barriers.
• Monitor and manage member progress, modify plans as needed, and document all actions.
• Collaborate with physicians, facilities and internal teams to ensure appropriate care across settings.
• Educate members and promote proactive engagement to improve outcomes and manage costs.
• Review medical necessity and eligibility of services as defined by department.
• Develop policies, procedures, or training as needed for internal or external use.

Skills

RN license

Case management

Education

RN Nursing degree

Job description

Job Description

We're hiring a Case Manager to join the FEP Case Management Team! Dependent on clinical discipline, the Case Manager 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.

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 Bring

• 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.
• Incumbent must obtain Certified Case Manager (CCM) certification within 2 years of employment.

Bonus Points (Preferred qualifications)

• Case Management experience is strongly preferred.
• Telephonic case management experience is strongly preferred.
• Certified Case Manager (CCM) certification preferred.
• EMR (electronic medical records) experience is preferred.
• Strong technical aptitude and ability to learn new systems quickly.

WhatYou'llGet

• 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

WhereYou'llWork

Our Hybrid Flex approach is builton presencewith a purpose - giving you flexibility to work remotely with intentional in-person connection - that supports a workplacethat'sflexible, connected, and future focused.

In a Hybrid-Flex role,you'llwork in the office at least two days a week for collaboration and connection. In a Remote Flex role,you'llwork 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