Episodic Care Manager
Blue Cross NC · United States · US
Utilization Review
Remote/Hybrid — check advert
physician
Nurse
Dentist
Demand78
Career growth62
Healthcare fit78
Remote potential88
Salary band
USD 74k – 118k
5-year outlook
The posted base range is $73,698 to $117,917 plus incentive bonus, which is consistent with payer-side utilization review roles. Growth may come through utilization management leadership, specialized payer roles, or case management, though progression often depends on additional credentials or management experience.
Clinical license
Required
Applicant reach
moderate
Seniority
mid
Employment type
full-time
Date found
2026-10-29
Intelligence details
Flexible work details
- Engagement type
- Permanent
- Hours
- Full-time
- Eligible countries
- United States
- License jurisdiction
- US
- Profession fit
- physician, Nurse, Dentist
- Rate period
- Annual
Listing via Himalayas.
Eligibility, licensing, and location restrictions can change. Always confirm details on the source posting before applying.
Why this is worth applying to
Worth considering for licensed RNs or LPNs who want payer-side utilization review with remote flexibility and predictable work. Physicians and clinicians without RN/LPN licensure are not the target profile for this posting.
Who should apply
RNs with 3+ years or LPNs with 5+ years of clinical experience, especially those with inpatient, outpatient, DME, case management, or managed care exposure and NC/compact licensure.
CV angle
Frame clinical experience around medical necessity assessment, guideline application, clinical documentation, interdisciplinary coordination, regulatory compliance, and cost-effective care. Quantify review volume, turnaround times, provider communication, and complex case coordination where possible.
Skills to highlight
- Medical necessity review
- Utilization management
- Clinical documentation review
- Care coordination
- Regulatory compliance
- Provider communication
- Clinical analysis
- Case management
Role summary
A payer-side utilization review role performing clinical reviews for medical necessity, benefits, and care guidelines across inpatient, outpatient, and DME cases. The position coordinates with providers, members, and medical directors and supports high-quality, cost-effective care.
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