Nurse Case Manager, Case Management

MagnaCare; Chapel Hill (NC); On-site; USD 65,000 - 80,000; Full time

Job summary

A leading healthcare solutions provider in North Carolina is seeking a Nurse Case Manager to oversee case management services. The successful candidate will develop care plans, communicate with patients and providers, and ensure adherence to healthcare regulations. This role requires a current RN license and a minimum of 2 years’ experience in case management, alongside excellent organizational and communication skills. Join a team committed to transforming healthcare delivery and creating a positive impact on patient lives.

Qualifications

• Minimum of 2 years of Case Management experience required, preferably with 4 years of clinical experience.
• Independent problem resolution and critical decision-making abilities.
• Strong skills in prioritization, planning, and multitasking.

Responsibilities

• Develop and manage the case management program, ensuring compliance with regulatory guidelines.
• Communicate with patients and stakeholders to ensure positive outcomes.
• Facilitate discharge planning and evaluate treatment alternatives.

Skills

Medical assessment skills

Customer service

Communication

Organization

Multitasking

Education

Current licensed Registered Nurse (RN)

Bachelor's degree

Tools

Microsoft Word

Microsoft Office

Microsoft Excel

Database environment

Job description

Join to apply for the Nurse Case Manager, Case Management role at MagnaCare

About The Role

Brighton Health Plan Solutions (BHPS) provides Case Management services to its clients. Cases are maintained by the Nurse Case manager. The Nurse Case Manager reports to the Manager of Case Management. The incumbent is responsible for developing and managing the case management program and providing case management services to members. Additionally, this position ensures appropriate systems are in place to collect and report program activities and outcomes for the case management program.

Primary Responsibilities

• Adheres to regulatory regulations (e.g., ERISA, HIPAA) for Case Management and self-insured clients
• Uses clinical tools for patient assessment, creating individualized care plans
• Communicates with patients, physicians, DME providers, etc., to ensure positive outcomes
• Educates patients and families about treatment plans, medications, and goals
• Establishes insurance coverage eligibility for medical costs
• Utilizes internal and external resources for Case Management
• Determines appropriate care level and resource utilization for complex cases
• Facilitates discharge planning and evaluates alternative treatments
• Maintains accurate records of cases, ensuring cost‑effective care
• Demonstrates compassion, care, and positivity with customers and colleagues
• Adheres to BHPS policies and quality assurance standards
• Participates in QA activities

Essential Qualifications

• Maintain relevant licensure(s), specialty certifications, and Case Management Certification
• 2 years’ Case Management experience required, preferably with 4 years' clinical experience
• Strong medical assessment/record review skills for effective problem-solving and decision‑making
• Independent problem resolution and critical decision‑making abilities
• Excellent prioritization, planning, and multitasking skills
• Effective customer service, communication, and organizational skills
• Proficiency in Microsoft Word, Office, Excel, and working in a database environment
• Familiarity with URAC/NCQA standards, Milliman Care Guidelines (MCG) – experience preferred
• Additional certifications such as Diabetes educator, Pediatric Nursing, Gerontological Nursing, Maternity Nursing, Population health, Disease Management (bonus)
• Current licensed Registered Nurse (RN) with compact state licensure; bachelor’s degree preferred
• General knowledge of HIPAA Confidentiality Laws

About the Company

Brighton Health Plan Solutions, LLC is committed to improving how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture that encourages respect, inclusion, and a sense of belonging at every level. We partner with self‑insured employers, Taft‑Hartley Trusts, health systems, providers, and other TPAs to solve today’s healthcare challenges with flexible, cutting‑edge services. We aim to transform the health plan experience by bringing outstanding products and services to our partners and redefining health‑care quality and value through innovative technology and award‑winning networks.

Equal Opportunity Employer

• We are an Equal Opportunity Employer.