FEP Case Manager

Blue Cross NC

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

Posted 10/13/2026full-timeRemote • United StatesMid-LevelSenior💰 $73,698 - $117,917 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in case management, including comprehensive assessments, care coordination, and resource utilization, while effectively collaborating with multidisciplinary teams to achieve optimal clinical outcomes. Holds a valid RN license and is committed to obtaining Certified Case Manager (CCM) certification.

Highest-signal resume keywords

RN LicenseCertified Case Manager (CCM)Case Management ExperienceTelephonic Case Management ExperienceEMR Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Comprehensive AssessmentCare CoordinationResource UtilizationTreatment PlanningDischarge PlanningMonitoring and EvaluationDocumentationEducation and OutreachBarriers IdentificationPolicy Development

Soft Skills

CollaborationCommunicationProblem-SolvingProactive InterventionAdaptability

Certifications & Qualifications

Certified Case Manager (CCM)

Industry Keywords

Healthcare ResourcesMember-Centric PlansContinuum of CareHigh-Risk Member OutreachMedical Necessity Evaluation

About the role

Key responsibilities & impact

Coordinate appropriate 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
Serve on a multidisciplinary team coordinating care, resources, and services
Perform comprehensive assessments and collaborate on treatment, intervention, and discharge planning
Develop member-centric plans tailored to needs, health status, education, and support needs
Identify barriers to goals or plans of care
Utilize community resources and funding sources
Monitor and manage members through scheduled follow-up, education, referrals, documentation, progress assessment, and plan modification
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 assessment, planning, 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)
Must obtain Certified Case Manager (CCM) certification within 2 years of employment
Case Management experience strongly preferred
Telephonic case management experience strongly preferred
Certified Case Manager (CCM) certification preferred
EMR (electronic medical records) experience preferred
Strong technical aptitude and ability to learn new systems quickly

Benefits

Comp & perks

Work-life balance, flexibility, and autonomy
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
401(k) match including an annual company contribution
Paid Time Off (PTO)
Annual Incentive Bonus based on annual corporate goal achievement and individual performance