Blue Cross NC · 13 hours ago
Case Manager - Medicare Advantage
United States
Full-time
Remote
Mid Level
$74K/yr - $118K/yr
3+ years expBlue Cross NC is a health organization seeking a Case Manager for their Medicare Advantage program. The role involves coordinating care and resources for selected member populations, promoting effective utilization of healthcare resources, and collaborating with healthcare teams to achieve optimal outcomes.
Financial ServicesHealth InsuranceInsurance
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 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
Qualification
Required
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 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
Benefits
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
Company
Blue Cross NC
It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Tunde Sotunde
President and Chief Executive Officer
Caleb Davies
Medicaid Market CFO - Healthy Blue of NC Medicaid
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