Remote Medicare Case Manager - Care Coordination

Blue Cross and Blue Shield of North Carolina; Ohio; À distance; USD 74 000 - 118 000; Plein temps

Avantages offerts par ce poste

Medical, dental, and vision coverage

401(k) with employer match

PTO

Annual Incentive Bonus

Wellness programs

Résumé du poste

Blue Cross NC is seeking a Case Manager to join the Medicare Case Management team. You will coordinate care, resources, and services for members to drive quality outcomes in a remote-flex setting.

RN with 3 years of case management experience and an active NC or multi-state license is required; CCM/CDCES may be preferred and must be obtained within 2 years. The role offers flexibility, robust benefits, and a supportive environment.

Qualifications

• 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.

Responsabilités

• Coordinate care, resources and/or services for members to achieve optimal clinical and resource outcomes.
• Perform comprehensive assessments to determine how to best collaborate with members, family, internal partners and external services/providers on plans for treatment, intervention and discharge planning.
• Develop a member-centric plan tailored to members' needs, health status and support needs; identify barriers to goals.
• Utilize community resources and funding sources as needed in the plan of care.
• Monitor and manage the member with follow-ups, referrals, and progress assessments.
• Evaluate care across the continuum of care (office, hospital, rehab, SNF, home care).
• Educate members and encourage proactive intervention to limit expense and improve outcomes.
• Document all aspects of the plan from assessment to evaluation.
• Outreach to high risk/high cost members when needed.
• Review alternative treatment plans and assess benefits access or flex options.
• Develop relevant policies/procedures, education or training for internal/external use.

Connaissances

Care Plan Development

Care Planning

Clinical Outcomes

Health Care

Healthcare Utilization Management

Nursing Fundamentals

Patient Advocacy

Patient Care

Patient Care Coordination

Patient Evaluations

Formation

RN license

NC or compact multi-state licensure

Description du poste

Blue Cross NC is seeking a Case Manager to join the Medicare Case Management team. You will coordinate care, resources, and services for members to drive quality outcomes in a remote-flex setting.

RN with 3 years of case management experience and an active NC or multi-state license is required; CCM/CDCES may be preferred and must be obtained within 2 years. The role offers flexibility, robust benefits, and a supportive environment.