Sr Case Manager--Onsite at Avance Care (Durham)

Blue Cross and Blue Shield of North Carolina
paid time off, 401(k)
United States, North Carolina, Durham
4613 University Drive (Show on map)
Jan 07, 2025
Job Description Dependent on clinical discipline, the Onsite Patient Navigator 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. Effectively coordinate with providers, members, and internal staff to support the delivery of high quality and cost-effective care across the health care system. 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 by addressing physical and behavioral health needs. 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. Perform clinical reviews to assess, facilitate, and coordinate the delivery of health care services for members based on medical necessity and contractual benefits. Communicate and collaborate effectively with internal and external clinical/non-clinical staff (including MDs) to coordinate work. Coordinate services and equipment to facilitate a safe and effective discharge plan, and perform appropriate associated authorizations. 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. Make referrals to internal and external resources to address barriers and provide additional support to members. Position is required to be onsite at assigned facility Mon-Fri 8A-5P. What You'll Bring (Hiring Requirements) RN with 3 years of clinical and/or case management experience required Additional direct experience in case management with demonstrated success in the Case Manager role, meeting or exceeding metrics and quality goals Proven expertise in CM functions and processes Must have a valid nursing license (or for Behavioral Health, other relevant clinical license) within the US and have started application for NC license 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. $75,900.00 - $136,600.00