Remote Medicare Case Manager

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

Benefits offered by this job

Medical, dental, vision coverage

401k with employer match

PTO and parental leave

Tuition reimbursement

Remote Flex with occasional in-office:

Job summary

Blue Cross NC is seeking a Case Manager to join the Medicare Case Management team. You will coordinate care and resources for members, perform assessments, and develop tailored plans to meet health and support needs.

The role involves collaboration with healthcare teams to optimize outcomes and control costs. The position supports a remote-flex work arrangement with some in-office visits and is open to candidates across the United States.

Qualifications

• RN with 3 years of clinical and/or case management experience.
• Valid RN license (NC or compact multi-state) to practice.
• Certifications such as CCM or CDCES may be required; if so, obtain within 2 years.

Responsibilities

• Coordinate care, resources and services for members to achieve optimal outcomes.
• Perform comprehensive assessments to plan treatment and discharge needs.
• Develop member-centric plans addressing health status and support needs.
• Utilize community resources and funding in care planning.
• Monitor progress, adjust plans, and document outcomes.
• Evaluate care across the continuum (office, hospital, rehab, home care).
• Educate members to promote proactive care and reduce costs.
• Document all plan stages from assessment to evaluation.
• May outreach to high-risk or high-utilization members.
• Review treatment plans and benefits as needed; support policy development.

Skills

Care Plan Development

Care Coordination

Nursing Fundamentals

Patient Advocacy

Healthcare Utilization Management

Education

RN license (NC or compact)

Job description

Blue Cross NC is seeking a Case Manager to join the Medicare Case Management team. You will coordinate care and resources for members, perform assessments, and develop tailored plans to meet health and support needs.

The role involves collaboration with healthcare teams to optimize outcomes and control costs. The position supports a remote-flex work arrangement with some in-office visits and is open to candidates across the United States.