Remote Flex Episodic Care Manager (RN/LPN)

Blue Cross NC; North Carolina; Teletrabalho; USD 74 000 - 118 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Medical, dental, and vision coverage

Parental leave and surrogacy support

401k match and company contribution

Career development programs

Resumo da oferta

Blue Cross NC is hiring an Episodic Care Manager for the Commercial Clinical UM Team. You will perform clinical reviews to assess medical necessity and coordinate care with providers, members, and internal staff.

This remote-flex role supports a national footprint with occasional in-office visits as needed. Ideal candidates are RN with 3 years or LPN with 5 years of clinical experience and an active NC or compact multi-state license.

Qualificações

• RN with 3 years of clinical experience or LPN with 5 years of clinical experience.
• Must have and maintain a valid NC or compact multi-state clinical license to perform duties.

Responsabilidades

• Perform clinical reviews for medical necessity and care coordination.
• Coordinate with providers, members, and internal staff to ensure quality, cost-effective care.
• Provide timely notifications to members and/or providers as required by regulations.
• Assess appropriateness for secondary review by Medical Director and coordinate as needed.
• Coordinate peer-to-peer reviews upon provider request when guidelines are not met.

Conhecimentos

RN with 3 years clinical experience

LPN with 5 years clinical experience

Descrição da oferta de emprego

Blue Cross NC is hiring an Episodic Care Manager for the Commercial Clinical UM Team. You will perform clinical reviews to assess medical necessity and coordinate care with providers, members, and internal staff.

This remote-flex role supports a national footprint with occasional in-office visits as needed. Ideal candidates are RN with 3 years or LPN with 5 years of clinical experience and an active NC or compact multi-state license.