Sr. Onsite Clinical Care Navigator (New Bern, NC - CarolinaEast Medical Center)

Sr. Onsite Clinical Care Navigator

We're hiring a Sr. Onsite Clinical Care Navigator to join the Commercial Case Management Team! Dependent on clinical discipline, the Onsite Clinical Care Navigator coordinates appropriate care, resources and/or services of selected member populations. Provides guidance and promotes effective utilization and monitoring of health care resources to drive quality care for our members. Collaborates as needed with varied members of the healthcare team to achieve optimal clinical and/or resource outcomes. Effectively coordinate with providers, members, and internal staff to support the delivery of high quality and cost-effective care across the health care system.

What You'll Do

• Serve as a team member on a multidisciplinary team, coordinating care, resources and/or services for members to achieve optimal clinical and resource outcomes by addressing physical and behavioral health needs.
• 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.
• Perform clinical reviews to assess, facilitate, and coordinate the delivery of health care services for members based on medical necessity and contractual benefits.
• Communicate and collaborate effectively with internal and external clinical/non-clinical staff (including MDs) to coordinate work.
• Coordinate services and equipment to facilitate a safe and effective discharge plan. And perform appropriate associated authorizations.
• 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.
• Make referrals to internal and external resources to address barriers and provide additional support to members.
• Position is required to be onsite at assigned facility Mon-Fri 8A-5P.

What You Bring

• RN or other applicable licensure as indicated by business area
• Minimum of 3 years of clinical experience
• Must have additional direct experience with and knowledge of case management and utilization management functions and processes.
• Must have a valid nursing license (or other relevant clinical license) within the US (NC or multistate/compact licensure required).
• Preferred: CCM Certification (within 12 months of hire)

What You'll Get

• The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community
• Work-life balance, flexibility, and the autonomy to do great work
• Medical, dental, and vision coverage along with numerous health and wellness programs
• Parental leave and support plus adoption and surrogacy assistance
• Career development programs and tuition reimbursement for continued education
• 401k match including an annual company contribution
• Learn more

Where You'll Work

Our Hybrid Flex approach is built on presence with a purpose giving you flexibility to work remotely with intentional in-person connection that supports a workplace that's flexible, connected, and future focused.

In a Hybrid-Flex role, you'll work in the office at least two days a week for collaboration and connection. In a Remote Flex role, you'll work virtually, with a few in-office visits each year for meaningful moments that matter.

Whether your role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any states listed on this job posting. Onsite expectations will be discussed during the interview process.

Salary Range

$89,174.00 - $142,679.00

Skills

Care Planning, Clinical Care, Clinical Coordination, Clinical Evaluations, Clinical Experience, Health Care, Nursing Fundamentals, Patient Advocacy, Patient Care, Patient Care Coordination, Patient Discharge Planning, Patient Education

_____________________________________________________________________JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on . If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: View email address on click.appcast.io.