Sr. Onsite Clinical Care Navigator - Fayetteville, NC

Job Description

We’re hiring a Sr. Onsite Clinical Care Navigator to join the Commercial Case Management Team! Dependent on clinical discipline, the Sr. 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

• 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.
• Engagement of members both in person and telephonically at assigned facility.
• 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.
• 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 9am-6pm EST.

What You Bring

• RN 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  

Where You’ll Work  

• This position is required to be onsite at assigned facility Mon-Fri 9am-6pm EST.
• Onsite Location: Beyond Blue NC Neighborhood Center - Bordeaux Shopping Center. 1800 Owen Dr. Fayetteville, NC 28304.

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.
 

$89,174.00 - $142,679.00

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

_____________________________________________________________________

JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: HR.Staffing@BCBSNC.com.