Case Manager

Blue Cross NC

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

Posted 11/3/2026full-timeUnited 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 comprehensive assessments to optimize clinical outcomes for member populations. 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 DocumentationEvaluation of Medical Necessity

Soft Skills

CollaborationEducation and OutreachProactive Intervention

Certifications & Qualifications

CCM CertificationCDCES Certification

Industry Keywords

Healthcare ResourcesMember-Centric CareContinuum of CareHigh-Risk Case ManagementAlternative Treatment Plans

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 goals
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 cases as needed
Review alternative treatment plans and assess benefits, exceptions, or flex benefit options
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; if required, obtain it within 2 years of employment
At this time, 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
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
Work-life balance, flexibility, and autonomy
Remote Flex work with a few in-office visits each year