Remote RN Case Manager – Medicare Care Coordination

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

401k with match

PTO

Tuition reimbursement

Parental leave

Job summary

Blue Cross NC is hiring a Case Manager to coordinate care, resources, and services for Medicare members. The role emphasizes collaboration with the health care team to optimize clinical and resource outcomes and to monitor utilization.

The position supports a remote/hybrid work model with flexible onsite visits and the potential to work from multiple locations in the U.S. An NC-licensed RN with 3 years of experience is required, with licensure and possible CCM/CDCES certification within 2 years.

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).
• For some roles, additional specialty certification (e.g. CCM, CDCES) may be required; must obtain 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 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, intervention and 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 with follow-ups, discussions of plan with member, referrals with documentation, progress assessment, and plan modifications.
• Evaluate and facilitate care provided to members through the continuum of care (office, hospital, rehab, SNF, 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 initial assessment to evaluation outcomes.
• May outreach directly to high risk or high utilization members.
• May review alternative treatment plans and assess benefits/exceptions.
• May evaluate medical necessity and appropriateness of services as defined by department.
• As needed, develop policies/procedures, education or training.

Skills

Care Plan Development

Care Planning

Clinical Outcomes

Health Care

Utilization Management

Nursing Fundamentals

Patient Advocacy

Patient Care

Patient Coordination

Patient Evaluations

Job description

Blue Cross NC is hiring a Case Manager to coordinate care, resources, and services for Medicare members. The role emphasizes collaboration with the health care team to optimize clinical and resource outcomes and to monitor utilization.

The position supports a remote/hybrid work model with flexible onsite visits and the potential to work from multiple locations in the U.S. An NC-licensed RN with 3 years of experience is required, with licensure and possible CCM/CDCES certification within 2 years.