Job Description

In the role of Social Worker - Behavioral Health, your clinical expertise will be needed to coordinate appropriate care, resources, and services for specific member populations as a Case Manager/Health Coach. You will provide guidance and encourage effective utilization and monitoring of healthcare resources to ensure quality care for our members. Collaboration with various healthcare team members will be necessary to achieve optimal clinical and resource outcomes

• Serve as a team member on a multidisciplinary team, coordinating care, resources and/or services for members to achieve optimal clinical and resource outcomes.

• 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.

• 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.

• Perform ongoing monitoring and management of member which may include scheduled 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 and facilitate care 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 the initial assessment, development of the plan, implementation, monitoring, and evaluating outcome.

• May outreach directly to members identified as high risk, high cost, or high utilization cases.

• 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 by department.

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

Hiring Requirements

• LCSW, LCMHC with 3 years of clinical and/or case management experience required. For some roles a Master's in Social Work with 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 and maintain a valid and applicable clinical license (NC or compact multi-state licensure) to perform described job duties.

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

Preferred Skills

• Experience with Behavioral Health Case Management

• Experience working with interdisciplinary team

• Available to work M-F between the hours of 8a-8p EST, rotating, as needed.

Salary Range

$61,900.00 - $99,000.00

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.

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

Much more than a paycheck

The total value of working at Blue Cross NC goes far beyond your paycheck. We offer benefits and perks (https://careers.bluecrossnc.com/global/en/benefits) that help you thrive, such as competitive health benefits, bonus plans based on performance, 401(k) with employer match, paid time off (plus two well-being days), and a variety of career development and wellness programs.