Job Description

The Sr. Behavioral Health Case Manager – DSNP leverages advanced knowledge and experience in case management to execute diverse senior-level functions within the department. This role involves collaborative engagement with members, driving operational efficiencies, coordinating with both internal and external stakeholders, and contributing to valuable Case Management (CM) initiatives. These efforts support the delivery of high-quality care across the healthcare system, positively influencing medical cost trends.

Acts as a subject matter expert (SME) to support clinical CM staff as first point of contact with process, business, and/or clinical questions.May provide coverage for representation on projects in place of leadership as needed due to other priorities.Serve as point of contact for internal and external stakeholders to provide expertise on case management related to projects/initiative support; support for testing or testing coordination when needed.Support team effectiveness through management of CM task lists and work assignments; management of queues in UM (Medicare Advantage MA)Maintain up to date knowledge of departmental processes/documentation standards to support precepting, training and staff meetings as necessary as well as completing process updates as needed.Actively monitor care management identification and segmentation results, engagement rates, and performance guarantees to address any issues identified.Collaborates with the case management leadership team to develop strategies and identify any adjustments needed to meet established goals. Please note: This position does not involve any performance discussions with staff or initiating any disciplinary action.Keep CM team members abreast and informed of any applicable client, benefit, or process updates.Manage smaller caseload as needed, coordinating care and services for members; promoting effective utilization and monitoring of resources and collaborating with all members of the healthcare team to achieve optimal clinical and resource outcomes. 

Hiring Requirements

RN or LCSW with 3 years of clinical and/or case management experience required.For Behavioral Health specific roles, other applicable licensure may be considered (LCSW, LPC, etc) with a minimum of 3 years of clinical experience.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