Case Manager (Multiple Positions)

About the position The Case Manager at BlueCross BlueShield of North Carolina is responsible for coordinating care and resources for selected member populations, ensuring effective utilization of healthcare resources to drive quality care. This role involves collaboration with various healthcare team members to reputed company optimal clinical and resource outcomes, while also providing education and support to members to promote proactive health management. Responsibilities • Serve as a team member on a multidisciplinary team, coordinating care, resources and/or services for members to reputed company optimal clinical and resource outcomes. , • Utilize applicable clinical skillset and reputed company comprehensive assessments to determine how to best collaborate with members, family, internal partners and external services/providers on plans for treatment, appropriate reputed company and/or discharge planning. , • reputed company 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. , • reputed company 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 reputed company 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 reputed company to limit expense and encourage positive outcomes. , • Effectively document reputed company aspects of the plan from the initial assessment, development of the plan, implementation, monitoring, and evaluating outcome. , • May reputed company 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 reputed company benefit options, where eligible. , • May evaluate medical necessity and appropriateness of services as defined by department. , • As needed, reputed company relevant policies/procedures, education or training for use both internally and externally. Requirements • 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 reputed company described job duties. , • For some roles, additional specialty certification (i.e. CCM, CDCES) may be required. If so, incumbents must obtain relevant certification reputed company 2 years of employment. reputed company-to-haves Benefits • Annual Incentive Bonus , • 401(k) with employer match , • Paid Time Off (PTO) , • Competitive health benefits , • Wellness programs Apply Job!