Onsite Clinical Care Navigator (Charlotte NC, Atrium Health)

Blue Cross and Blue Shield of North Carolina

2d • $89,174 - $142,679 • Onsite

About The Position

This is an Onsite M-F position. Charlotte NC - Atrium Health locations (Cabarrus and University City). We’re hiring a Sr. Onsite Clinical Care Navigator to join the Commercial Case Management Team! Dependent on clinical discipline, the 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.

Requirements

• 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).

Nice To Haves

• CCM Certification (within 12 months of hire)

Responsibilities

• 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 facility Mon-Fri 8A-5P.

Benefits

• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed