Senior Onsite Clinical Care Navigator--WakeMed Raleigh

Job Description

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

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.

Skills