Remote RN Medicare Case Manager

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

Benefits offered by this job

Medical, dental, and vision coverage

Parental leave and adoption/surrogacy

401(k) match

Job summary

Blue Cross NC is seeking a Case Manager to join the Medicare Case Management team. The role coordinates care, resources and services for selected member populations, promoting quality outcomes in collaboration with the health care team.

This remote‑flex position requires an RN with 3 years of clinical/case management experience and a valid license (NC or compact). CCM/CCDS certification may be needed within 2 years of employment. Competitive compensation and benefits are offered.

Qualifications

• RN with 3 years of clinical and/or case management experience.
• Must hold a valid clinical license (NC or compact multi‑state).
• CCM or CDCES may be required; if so, obtain within 2 years of employment.

Responsibilities

• Coordinate care, resources and services for members to achieve optimal outcomes.
• Perform comprehensive assessments to plan treatment, intervention and discharge planning.
• Develop member-centered care plans addressing needs, status, and support levels.
• Utilize community resources and funding in plan development.
• Monitor and manage members with appropriate follow-up and referrals.
• Evaluate care across the continuum (clinic, hospital, home, etc.).
• Educate members to promote proactive care and cost management.
• Document all plan steps from assessment to outcome evaluation.
• May outreach to high‑risk or high‑cost members as needed.
• May review treatment options and benefits needs or exceptions.

Skills

RN with 3 years experience

Education

RN license in NC or compact state

Job description

Blue Cross NC is seeking a Case Manager to join the Medicare Case Management team. The role coordinates care, resources and services for selected member populations, promoting quality outcomes in collaboration with the health care team.

This remote‑flex position requires an RN with 3 years of clinical/case management experience and a valid license (NC or compact). CCM/CCDS certification may be needed within 2 years of employment. Competitive compensation and benefits are offered.