Case Manager

Blue Cross NC

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

Posted 11/4/2026full-timeUnited StatesMid-LevelSenior💰 $73,698 - $117,917 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in care coordination, resource management, and comprehensive assessments to optimize clinical outcomes. Proficient in developing member-centric care plans and utilizing community resources effectively.

Highest-signal resume keywords

RN LicenseClinical Case Management ExperienceCare CoordinationTelephonic Case ManagementHealth Insurance Industry Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Comprehensive AssessmentsTreatment CoordinationDischarge PlanningMonitoring and DocumentationPolicy Development

Soft Skills

CollaborationEducationProactive Intervention

Certifications & Qualifications

CCMCDCES

Industry Keywords

Healthcare ResourcesMember-Centric CareMedical Necessity EvaluationHigh-Risk Member OutreachContinuum of Care

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 treatment, interventions, and discharge planning
Develop member-centric plans of care and identify barriers to meeting goals
Utilize community resources and funding sources
Monitor and manage members through scheduled 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
Evaluate medical necessity and appropriateness of services
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
Previous telephonic/remote case management experience preferred
Previous experience working in the health insurance industry preferred

Benefits

Comp & perks

Medical, dental, and vision coverage
Health and wellness programs
Work-life balance and flexibility
Parental leave
Adoption and surrogacy assistance
Career development programs
Tuition reimbursement for continued education
401(k) match including an annual company contribution
Paid Time Off (PTO)
Annual Incentive Bonus
Remote Flex work with a few in-office visits each year