Remote Medicare Case Manager & Care Coordinator

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

Benefits offered by this job

Medical benefits including vision

401k match

PTO and wellness programs

Parental leave and adoption support

Job summary

Blue Cross NC is seeking a Case Manager to coordinate care and resources for Medicare members, supporting treatment plans and discharge planning. You will collaborate with physicians, nurses, and external providers to ensure optimal outcomes and appropriate utilization of services.

The role requires RN credentials with 3 years of case management experience, a valid clinical license, and potential CCM/CCDES certification within 2 years.

Qualifications

• RN with 3 years of clinical and/or case management experience.
• Must have and maintain a valid and applicable clinical license (NC or compact multi-state licensure).
• For some roles, additional specialty certification (i.e. CCM, CDCES) may be required and must be obtained within 2 years of employment.

Responsibilities

• 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.

Skills

RN

Case management

Clinical experience

Licensure

Job description

Blue Cross NC is seeking a Case Manager to coordinate care and resources for Medicare members, supporting treatment plans and discharge planning. You will collaborate with physicians, nurses, and external providers to ensure optimal outcomes and appropriate utilization of services.

The role requires RN credentials with 3 years of case management experience, a valid clinical license, and potential CCM/CCDES certification within 2 years.