Offer summary

Qualifications:

Registered Nurse (RN) license with valid clinical credentials., At least 3 years of transplant clinical or case management experience., Specialty certification such as CCM required within 2 years of employment., Strong skills in care plan development, patient advocacy, and healthcare utilization management..

Key responsibilities:

Coordinate care and resources for members to achieve optimal outcomes.

Perform comprehensive assessments and develop member-centric care plans.

Monitor and manage members through ongoing follow-up and intervention.

Document all aspects of care plans and evaluate treatment effectiveness.

Job description

Job Description

Dependent on clinical discipline, the Case Manager / Health Coach coordinates appropriate care, resources and/or services of selected member populations. Provides guidance and promotes effective utilization and monitoring of health care resources to drive quality care for our members. Collaborates as needed with varied members of the healthcare team to achieve optimal clinical and/or resource outcomes.

What You'll Do

Serve as a team member on a multidisciplinary team, coordinating care, resources and/or services for members to achieve optimal clinical and resource outcomes
Utilize applicable clinical skillset and perform comprehensive assessments to determine how to best collaborate with members, family, internal partners and external services/providers on plans for treatment, appropriate intervention and/or discharge planning
Develop a member-centric plan tailored to members’ needs, health status, educational status and level of support needs; identify barriers to meeting goals or plan of care
Utilize community resources and funding sources as needed in the development of the plan of care
Perform ongoing monitoring and management of member which may include scheduled follow-up with member, discussion of plan with member, appropriate services/education to address needs, appropriate referrals with supporting documentation, assessment of progress towards goals, modification of plan/goals as needed, with contact frequency appropriate to member acuity
Evaluate and facilitate care provided to members through the continuum of care (physician office, hospital, rehabilitation unit, skilled nursing facility, home care, etc)
Educate members and encourage pro-active intervention to limit expense and encourage positive outcomes
Effectively document all aspects of the plan from the initial assessment, development of the plan, implementation, monitoring, and evaluating outcome.
May outreach directly to members identified as high risk, high cost, or high utilization cases
May review alternative treatment plans for case management candidates and assess available benefits and the need for benefits exception or flex benefit options, where eligible
May evaluate medical necessity and appropriateness of services as defined by department
As needed, develop relevant policies/procedures, education or training for use both internally and externally

What You'll Bring

RN with 3 years of transplant clinical and/or transplant case management experience required
Must have and maintain a valid and applicable clinical license (NC or compact multi-state licensure) to perform described job duties
For this role, additional specialty certification (i.e. CCM) will be required. Incumbents must obtain relevant certification within 2 years of employment

What You’ll Get

The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community 
Work-life balance, flexibility, and the autonomy to do great work  
Medical, dental, and vision coverage along with numerous health and wellness programs  
Parental leave and support plus adoption and surrogacy assistance  
Career development programs and tuition reimbursement for continued education  
401k match including an annual company contribution  
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Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

$68,200.00 - $109,100.00

Skills

Care Plan Development, Care Planning, Clinical Outcomes, Health Care, Healthcare Utilization Management, Nursing Fundamentals, Patient Advocacy, Patient Care, Patient Care Coordination, Patient Evaluations

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