Case Manager

Blue Cross NC

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

Posted 9/23/2026full-timeRemote • North Carolina • United 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, patient advocacy, and comprehensive assessments to optimize clinical outcomes. Proficient in developing member-centric care plans and utilizing healthcare resources effectively.

Highest-signal resume keywords

RN LicenseCase Management ExperienceCare Plan DevelopmentHealthcare Utilization ManagementPatient Care Coordination

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Care Plan DevelopmentClinical OutcomesPatient EvaluationsNursing FundamentalsPatient Advocacy

Soft Skills

CollaborationEducationMonitoringCommunication

Certifications & Qualifications

CCMCDCES

Industry Keywords

Health CareHealthcare ResourcesClinical NursingCare CoordinationDischarge Planning

About the role

Key responsibilities & impact

Coordinate care, resources, and 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 based on needs, health status, education, and support requirements
Identify barriers to goals and 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, plans, implementation, monitoring, and outcomes
Outreach to high-risk, high-cost, or high-utilization members when 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 may be required for some roles, such as CCM or CDCES; relevant certification must be obtained within 2 years of employment if required
At this time, Blue Cross NC will not sponsor employment authorization for this position
Additional non-compact state nursing licenses are strongly preferred
Broad clinical nursing experience across multiple care settings is highly desirable
Skills: Care Plan Development, Care Planning, Clinical Outcomes, Health Care, Healthcare Utilization Management, Nursing Fundamentals, Patient Advocacy, Patient Care, Patient Care Coordination, Patient Evaluations

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