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Job Description

Dependent on clinical discipline, the Onsite Clinical Care 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 (Job Responsibilites)

+ 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 Emergency Department facility Mon-Fri 11am-7pm and available to provide case management for BCNC inpatient members.

What You'll Bring (Hiring Requirements)

+ RN, LCSW or other applicable licensure as indicated by business area

+ Minimum of 3 years of clinical experience

+ Must have additional direct experience with and knowledge of case management and utilization management functions and processes.

+ Must have a valid nursing license (or other relevant clinical license) within the US (NC or multistate/compact licensure required)

+ Preferred: CCM Certification (within 12 months of hire)

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

+ Learn more (https://careers.bluecrossnc.com/global/en/benefits)

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

Skills

Care Planning, Clinical Care, Clinical Coordination, Clinical Evaluations, Clinical Experience, Health Care, Nursing Fundamentals, Patient Advocacy, Patient Care, Patient Care Coordination, Patient Discharge Planning, Patient Education

About Us

It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians.

Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all.

Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.

Authorization to Work in the United States

We use E-verify to confirm authorization to work in the United States. To learn more about E-Verify, including your rights and responsibilities, please visit E-Verify Overview (https://www.e-verify.gov/employees/e-verify-overview) for English or Visión General de E-Verify (https://www.e-verify.gov/es/empleados/vision-general-de-e-verify) for Español.

Request Accommodations

Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please notify HR at [email protected] .

For most roles, you can choose where to work - fully remote in one of the states listed below, in the office, or a hybrid of the two:

Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming