Case Manager

WhatYou'llDo

• Serve as a team member on a multidisciplinary team, coordinating care,resourcesand/or services for members to achieveoptimalclinical and resource outcomes.

• Utilize applicable clinical skillset and perform comprehensive assessments todeterminehow to best collaborate with members, family, internalpartnersand external services/providers on plans for treatment,appropriate interventionand/or discharge planning.

• Develop a member-centric plan tailored to members' needs, health status, educationalstatusand level of support needs;identifybarriers to meeting goals or plan of care.

• Utilize community resources and funding sources as needed in the development of the plan of care.

• Perform ongoing monitoring and management of member which may includescheduled follow-up with member, discussion of plan with member, appropriate services/education to address needs, appropriate referrals with supporting documentation, assessment of progress towards goals, modification of plan/goals as needed, with contact frequency appropriate to member acuity.

• Evaluate andfacilitatecare provided to members through the continuum of care (physician office, hospital, rehabilitation unit, skilled nursing facility, home care,etc).

• Educate members and encourage pro-active intervention to limit expense and encourage positive outcomes

• Effectively document all aspects of the plan from theinitialassessment, development of the plan, implementation, monitoring, and evaluating outcome.

• May outreach directly to members identified ashigh risk,high cost, or highutilizationcases.

• May review alternative treatment plans for case management candidates and assess available benefits and the need for benefits exception or flex benefit options, where eligible.

• May evaluate medical necessity and appropriateness of services as defined bydepartment.

• As needed, develop relevant policies/procedures,educationor training for use both internally and externally.

What You Bring

• RN,RDor LCSW with 3 years of clinical and/or case management experiencerequired. For somerolesaMaster's in Social Workwith 5 years of related experience may be considered.

• For Behavioral Health specific roles, other applicable licensure may be considered with a minimum of 3 years of clinical experience.

• Must have andmaintaina valid and applicable clinical license (NC or compact multi-state licensure) to perform described job duties.

• For some roles,additionalspecialty certification (i.e.CCM, CDCES) may berequired. If so, incumbents must obtain relevant certification within 2 years of employment.

Bonus Points(Preferred qualifications)

• Candidates withpediatricand NICUexperienceare highlypreferred.

• Telephonic case management experience is a plus.

WhatYou'llGet

• The opportunity to work at thecutting edgeof health care delivery with a teamthat'sdeeply invested in the community

• Work-life balance, flexibility, and the autonomy to dogreat work

• Medical, dental, and vision coverage along withnumeroushealth and wellness programs

• Parental leave and support plus adoption and surrogacyassistance

• Career development programs and tuition reimbursement for continued education

• 401k match including an annual company contribution

WhereYou'llWork

Our Hybrid Flex approach is builton presencewith a purpose - giving you flexibility to work remotely with intentional in-person connection - that supports a workplacethat'sflexible, connected, and future focused.

In a Hybrid-Flex role,you'llwork in the office at least two days a week for collaboration and connection. In a Remote Flex role,you'llwork virtually, with a few in-office visits each year for meaningful moments that matter.

Whether your role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any states listed on this job posting. Onsite expectations will be discussed during the interview process.