The BCBS Delegated Remote Case Manager collaborates with physicians, members, caregivers, and interdisciplinary healthcare teams to promote quality outcomes for members with complex medical, behavioral, and psychosocial needs. This role is responsible for identifying, assessing, enrolling, and managing members who may benefit from Case Management services through telephonic and virtual outreach. The Remote Case Manager develops individualized care plans, coordinates healthcare services across the continuum of care, facilitates care transitions, and promotes appropriate utilization of healthcare resources.

Essential Duties & Responsibilities

• Analyze health plan reports, predictive modeling tools, referrals, and clinical data to identify members eligible for Case Management services.

• Conduct comprehensive telephonic and virtual assessments to evaluate medical, behavioral, environmental, social, and support needs.

• Enroll and manage a caseload of members with complex health conditions.

• Develop, implement, monitor, and update individualized care plans with measurable goals and interventions.

• Coordinate healthcare services with providers and community resources.

• Facilitate transitions of care following hospital and post-acute discharges.

• Educate members and caregivers regarding disease management and benefits.

• Maintain accurate and timely documentation and reporting.

• Collaborate with Utilization Management, Quality, and Population Health teams.

• Perform other duties as assigned.

Knowledge, Skills & Abilities

• Knowledge of case management, care coordination, and population health principles.

• Strong communication, assessment, and critical thinking skills.

• Ability to work independently in a remote environment.

• Strong organizational and time management abilities.

• Proficiency with EMR systems, care management platforms, and Microsoft Office.

• Knowledge of community resources and social determinants of health.

Education / Certification

• Current unrestricted Registered Nurse (RN) license required.

• Bachelor of Science in Nursing preferred.

• CCM, ACM, or equivalent certification preferred.

Experience

• Minimum two years of clinical nursing experience required.

• Two years of case management, managed care, or population health experience preferred.

• Remote or telephonic case management experience preferred.

If you are committed to putting our patients first and helping shape the future of care, you belong at Duly.

The compensation for this role includes a base pay range of 67K-101K, with the actual pay determined by factors such as skills, experience, education, certifications, geographic location, and internal equity. Additional compensation may be available through shift differentials, bonuses, and other incentives. Base pay is only a portion of the total rewards package.

Artificial Intelligence Disclosure

Artificial Intelligence (AI) tools may be used in some portions of the candidate review process for this position, however, all employment decisions will be made by a person.

Artificial Intelligence Disclosure

Artificial Intelligence (AI) tools may be used in some portions of the candidate review process for this position, however, all employment decisions will be made by a person.