Case Manager

Blue Cross NC

. Coordinate care, resources and/or services for selected member populations .

Posted 10/2/2026full-timeRemote • United StatesMid-LevelSenior💰 $73,698 - $117,917 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in care coordination, resource management, and member-centric planning, with a focus on optimizing clinical outcomes and effective utilization of healthcare resources. Proficient in conducting comprehensive assessments and collaborating with multidisciplinary teams to address member needs and barriers to care.

Highest-signal resume keywords

Registered Nurse (RN)Clinical Case ManagementCare CoordinationMember-Centric PlanningClinical License (NC or Compact Multi-State)

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Comprehensive AssessmentsCare Plan DevelopmentMonitoring and DocumentationEvaluation of Medical NecessityUtilization of Community Resources

Soft Skills

CollaborationEducation and OutreachProblem-Solving

Certifications & Qualifications

CCMCDCES

Industry Keywords

Healthcare ResourcesHigh-Risk Member ManagementContinuum of CareTreatment GoalsPolicy Development

About the role

Key responsibilities & impact

Coordinate care, resources and/or services for selected member populations
Provide guidance and promote effective utilization and monitoring of health care resources
Collaborate with healthcare team members to achieve optimal clinical and resource outcomes
Perform comprehensive assessments and coordinate with members, families, internal partners, and external providers
Develop member-centric plans tailored to members’ needs, health status, education, and support needs
Identify barriers to treatment goals or plans of care
Utilize community resources and funding sources
Monitor and manage members through follow-up, education, referrals, documentation, and plan modifications
Evaluate and facilitate care across the continuum, including physician offices, hospitals, rehabilitation units, skilled nursing facilities, and home care
Educate members and encourage proactive intervention
Document assessments, care plans, implementation, monitoring, and outcomes
Outreach to high-risk, high-cost, or high-utilization members as needed
Review alternative treatment plans and assess benefits exceptions or flex benefit options as needed
Evaluate medical necessity and service appropriateness
Develop policies, procedures, education, or training as needed

Requirements

What you’ll need

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)
Additional specialty certification (e.g. CCM, CDCES) may be required for some roles; relevant certification must be obtained within 2 years of employment if required
Blue Cross NC will not sponsor employment authorization for this position

Benefits

Comp & perks

Medical, dental, and vision coverage
Health and wellness programs
Parental leave and support
Adoption and surrogacy assistance
Career development programs
Tuition reimbursement for continued education
401k match including an annual company contribution
Paid Time Off (PTO)
Annual Incentive Bonus
Flexible work arrangements
Work-life balance and autonomy