Case Manager

Job Description We’re hiring a Case Manager to join the Medicare Case Management Team! Dependent on clinical discipline, the Case Manager 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. 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. 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. What You Bring RN, RD or LCSW with 3 years of clinical and/or case management experience required. For some roles a Master's in Social Work with 5 years of related experience may be considered. For Behavioral Health specific roles, other applicable licensure may be considered with a minimum of 3 years of clinical experience. Must have and maintain a valid and applicable clinical license (NC or compact multi-state licensure) to perform described job duties. For some roles, additional specialty certification (i.e. CCM, CDCES) may be required. If so, incumbents must obtain relevant certification within 2 years of employment. Bonus Points (Preferred qualifications) Active RN license Prior hospital care experience is strongly preferred. Proficient with computers and Microsoft Office applications. Strong technical aptitude and ability to learn new systems quickly. Certified Case Manager (CCM) certification preferred. 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 At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. *Based on annual corporate goal achievement and individual performance. $73,698.00 - $117,917.00 Skills _____________________________________________________________________ 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.