**Job Description** Works onsite at the Raleigh-based Avance Care Behavioral Health Center of Excellence supporting Blue Cross NC members. Utilizes advanced knowledge and experience in case management to perform varied senior-level functions for the department. Engages collaboratively with members, drives operational efficiencies, coordinates with internal and external stakeholders and provides input to valuable case management initiatives that support the delivery of high-quality care across the health care system to positively impact medical cost trends. **What You'll Do** + Commute and work onsite at the Raleigh-based Avance Care Behavioral Health Center of Excellence and/or other local Avance Care clinics as needed. + Identify and monitor Blue Cross NC members with care gaps or other case management needs, 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. + Perform an assessment of each member’s behavioral health status and level of support needs. + Develop a member-centric care plan which includes a self-management plan tailored to member’s needs, linkage to community-based resources and care, referral to Blue Cross NC programs, and identification of barriers to following care plan. + Support with identifying in-network providers, scheduling follow-up appointments, educating on benefits, and addressing social drivers of health and access to care issues. + Serve as a liaison between the clinic and Blue Cross NC’s Utilization Management teams, communicating and/or evaluating medical necessity criteria and appropriateness of services. + Document all aspects of the case management process in health records as required and provide copies of the care plan to all members of the care team as requested. + Actively monitor program identification, engagement rates, and performance metrics to address any issues identified. + Collaborate with leadership team to develop strategies and identify any adjustments needed to meet established goals. + 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. **What You'll Bring - Hiring Requirements** + 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 + Proven expertise in case management and/or utilization management 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 **About Us** It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians. Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all. Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives. **Authorization to Work in the United States** We use E-verify to confirm authorization to work in the United States. To learn more about E-Verify, including your rights and responsibilities, please visit E-Verify Overview (https://www.e-verify.gov/employees/e-verify-overview) for English or Visión General de E-Verify (https://www.e-verify.gov/es/empleados/vision-general-de-e-verify) for Español. **Request Accommodations** Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please notify HR at HR.Staffing@bcbsnc.com . **For most roles, you can choose where to work - fully remote in one of the states listed below, in the office, or a hybrid of the two:** Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming