Episodic Care Manager

Bluecrossnc

Base: $73,698.00 - $117,917.00; bonus/equity: annu...
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Clinical evaluation and review
Medical necessity assessment
Provider and member coordination
** Blue Cross NC is seeking an Episodic Care Manager responsible for clinical reviews and coordination of healthcare services for members, ensuring medical necessity and compliance with contractual benefits. The ideal candidate will hold an RN or LPN license with significant clinical experience and will work in a supportive environment that values community engagement and work-life balance. **

Job Summary

  • The Episodic Care Manager is responsible for performing clinical reviews to assess, facilitate, and coordinate the delivery of health care services for members based on medical necessity and contractual benefits.
  • Effectively coordinate with providers, members, and internal staff to support the delivery of high quality and cost-effective care across the health care system.
  • Blue Cross NC offers 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.

Matching Summary

Match Score: 75

** Blue Cross NC is seeking an Episodic Care Manager responsible for clinical reviews and coordination of healthcare services for members, ensuring medical necessity and compliance with contractual benefits. The ideal candidate will hold an RN or LPN license with significant clinical experience and will work in a supportive environment that values community engagement and work-life balance. **

Salary

Base: $73,698.00 - $117,917.00; Bonus/Equity: Annual Incentive Bonus*; Benefits: Medical, dental, vision coverage, health and wellness programs, 401k match

Skills & Requirements

Must-have

  • Clinical evaluation and review
  • Medical necessity assessment
  • Provider and member coordination
  • Documentation of reviews
  • Interpret clinical information

Nice-to-have

  • Cutting edge health care delivery
  • Work-life balance and flexibility
  • Community investment

Key Requirements

  • RN with 3 years clinical experience
  • LPN with 5 years clinical experience
  • Valid applicable clinical license (NC or compact multi-state)

Work Rights

Not specified

Tailored Resume

Cover Letter