Case Manager

Blue Cross and Blue Shield of North Carolina

Job Overview

Location

Remote Flex - North Carolina

Job Type

Full-time

Full Job Description

📋 Description

• Serve as a team member on a multidisciplinary team to coordinate care, resources, and services for members to achieve optimal clinical and resource outcomes.
• Utilize clinical expertise to perform comprehensive assessments of members’ health status, educational background, and support needs to develop individualized care plans.
• Collaborate with members, families, internal partners, and external providers to design treatment plans, interventions, and discharge strategies.
• Identify barriers to achieving care goals and modify care plans accordingly based on member progress and evolving needs.
• Utilize community resources and funding sources to support member care plans and ensure access to necessary services.
• Conduct ongoing monitoring of members through scheduled follow-ups, discussions of care plans, education, referrals, and documentation of progress.
• Evaluate and facilitate care across the continuum, including physician offices, hospitals, rehabilitation units, skilled nursing facilities, and home care settings.
• Educate members on proactive health interventions to reduce expenses and improve health outcomes.
• Accurately document all phases of care management, including initial assessments, plan development, implementation, monitoring, and outcome evaluation.
• Outreach directly to members identified as high-risk, high-cost, or high-utilization cases to provide targeted support.
• Review alternative treatment plans for case management candidates and assess eligibility for benefits exceptions or flex benefit options.
• Evaluate medical necessity and appropriateness of services in alignment with department-defined criteria.
• Develop internal and external policies, procedures, education materials, or training programs as needed to support case management operations.

🎯 Requirements

• RN with 3 years of clinical and/or case management experience required.
• Must hold and maintain a valid and applicable clinical license (NC or compact multi-state licensure).
• For some roles, must obtain specialty certification (e.g., CCM, CDCES) 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.
• Work-life balance, flexibility, and autonomy to perform duties effectively.
• Opportunity to work at the cutting edge of health care delivery with a community-focused team.

Skills & Technologies

Remote

Ready to Apply?

Apply Externally

You will be redirected to an external site to apply.

AI Job Fit Analysis

Pro

See exactly how your profile matches this role — strengths, skill gaps, and what to do about them.

Blue Cross and Blue Shield of North Carolina

Visit Website

About Blue Cross and Blue Shield of North Carolina

Blue Cross and Blue Shield of North Carolina is a nonprofit health insurer domiciled in North Carolina, providing medical, dental, vision, Medicare, and Medicaid coverage to individuals, employers, and government programs. Founded in 1933, the company operates the largest provider network in the state and offers telehealth, pharmacy management, wellness, and care-coordination services. Its mission is to improve health care access, affordability, and outcomes for North Carolinians while maintaining community-focused, nonprofit governance.

View Company Profile

Get more remote jobs like this

Subscribe to the weekly newsletter for similar remote roles and curated hiring updates.

Weekly remote jobs and featured talent.

No spam. Only curated remote roles and product updates. You can unsubscribe anytime.