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Blue Cross Rn Remote Jobs in North Carolina (NOW HIRING)

Sagility

RN Utilization Management Reviewer

Concord, NC · Remote

$35 - $40/hr

Job title: RN Utilization Management Reviewer We are currently hiring a talented RN, Utilization ... May require weekends This is a fully remote work at home role. You must have a secure, private wok ...

Formic

Automation Sales Manager

Asheville, NC · Remote

Medical, dental, and vision insurance through Blue Cross Blue Shield and Unum, with 99% of employee ... A one-time allowance for fully remote and hybrid employees to support an at-home or on-the-road ...

SalvoHealth

Registered Dietitian, Remote

Charlotte, NC · Remote

$30.50 - $41/hr

... Remote Patient Monitoring ("RPM") to bill under the patient's insurance. This is a major step ... Work closely with a multidisciplinary team, including fellow registered dietitians, licensed nurses ...

SalvoHealth

Registered Dietitian, Remote

Charlotte, NC · On-site +1

$30.50 - $41/hr

... Remote Patient Monitoring ("RPM") to bill under the patient's insurance. This is a major step ... Work closely with a multidisciplinary team, including fellow registered dietitians, licensed nurses ...

Formic

Automation Sales Manager

Charlotte, NC · Remote

Medical, dental, and vision insurance through Blue Cross Blue Shield and Unum, with 99% of employee ... A one-time allowance for fully remote and hybrid employees to support an at-home or on-the-road ...

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Blue Cross Rn Remote information

What is a Blue Cross RN remote?

A Blue Cross RN Remote is a registered nurse who works remotely for Blue Cross Blue Shield, typically supporting members through telehealth, case management, care coordination, and health coaching. These nurses use phone, video calls, and digital platforms to assess patient needs, develop care plans, and provide education and support. Their role helps ensure that members receive high-quality care and guidance without needing in-person visits, making healthcare more accessible and convenient. Blue Cross RNs working remotely may also assist with pre-authorization, utilization management, or disease management programs.

How does a Blue Cross RN remote typically communicate and coordinate care with interdisciplinary team members?

As a remote Blue Cross RN, effective communication with physicians, case managers, social workers, and other healthcare professionals is essential. Most coordination occurs via secure digital platforms, video calls, and phone conferences, allowing for timely updates on patient progress and care plans. Regular virtual meetings and documentation in shared electronic health records ensure seamless teamwork and continuity of care. Building strong digital communication skills and being proactive about follow-ups are key to success in this remote setting.

What are the key skills and qualifications needed to thrive as a Blue Cross RN remote, and why are they important?

To excel as a Blue Cross RN Remote, you need an active RN license, clinical nursing experience (often in case management or utilization review), and strong assessment abilities. Familiarity with electronic medical record (EMR) systems, telehealth platforms, and case management software is typically required, along with certifications like CCM (Certified Case Manager) being advantageous. Exceptional communication, self-motivation, and organizational skills help nurses effectively support members and collaborate virtually with healthcare teams. These competencies ensure quality patient care, regulatory compliance, and efficient service delivery in a remote environment.

What is the difference between Blue Cross Rn Remote vs Blue Cross Lpn Remote?

AspectBlue Cross Rn RemoteBlue Cross Lpn Remote
Required CredentialsRegistered Nurse (RN) licenseLicensed Practical Nurse (LPN) license
Work EnvironmentRemote healthcare support, patient assessmentsRemote patient care, basic clinical tasks
Employer & Industry UsageHealth insurance companies, healthcare providersHealth insurance companies, healthcare providers
Common Search & ComparisonYesYes

Blue Cross Rn Remote and Blue Cross Lpn Remote roles both serve in remote healthcare settings within insurance companies and healthcare providers. The main difference lies in the required credentials: RNs need a registered nurse license, while LPNs require a practical nurse license. RNs typically handle more complex patient assessments, whereas LPNs focus on basic patient care tasks. Both roles are essential in remote healthcare support, but they differ in scope and qualification requirements.

What are popular job titles related to Blue Cross Rn Remote jobs in North Carolina?

For Blue Cross Rn Remote jobs in North Carolina, the most frequently searched job titles are:

What job categories do people searching Blue Cross Rn Remote jobs in North Carolina look for?

The top searched job categories for Blue Cross Rn Remote jobs in North Carolina are:

What cities in North Carolina are hiring for Blue Cross Rn Remote jobs?

Cities in North Carolina with the most Blue Cross Rn Remote job openings:

Blue Cross Rn Remote jobs near you
Infographic showing various Blue Cross Rn Remote job openings in North Carolina as of August 2026, with employment types broken down into 87% Full Time, 10% Part Time, and 3% Contract. Highlights an 100% Remote job distribution.

RN Utilization Management Reviewer

Sagility

Concord, NC • Remote

$35 - $40/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 9 days ago

Sagility rating

4.6

Company rating: 4.6 out of 10

Based on 29 frontline employees who took The Breakroom Quiz

62nd of 71 rated call and contact centers

Job description

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.

Job title:

RN Utilization Management Reviewer

Job Description:

We are currently hiring a talented RN, Utilization Management Reviewer. This role will be responsible in day-to-day timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring the client meets CMS compliance standards in the area of service decisions and organizational determinations. Successful candidates must hold a valid, current license issued by the Massachusetts Board of Registration in Nursing.

Key responsibilities:

  • Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical areas, including but not limited to surgical procedures, Medicare Part B medications, Long Term Services and Supports (LTSS), and Home Health (HH)
  • Applies established criteria (e.g., InterQual and other available guidelines) and employs clinical expertise to interpret clinical criteria to determine medical necessity of services
  • Communicates results of reviews verbally, in the medical record, and through official written notification to the primary care team, specialty providers, vendors and members in adherence with regulatory and contractual requirements
  • Provides decision-making guidance to clinical teams on service planning as needed
  • Works closely with Clinicians, Medical Staff and Peer Reviewers to facilitate escalated reviews in accordance with Standard Operating Procedures
  • Ensures accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy
  • Works with UM Manager and other clinical leadership to ensure that departmental and organizational policies and procedures as well as regulatory and contractual requirements are met
  • Additional duties as requested by supervisor
  • Maintains knowledge of CMS, State and NCQA regulatory requirements

Education Requirements:

  • RN - Associate's Degree required, Bachelor's Degree preferred
  • RN, current license issued by the Massachusetts Board of Registration in Nursing
  • CCM (Certified Case Manager) a plus

Required Experience (must have):

  • 1 to 2 years Utilization Management experience.
  • 2 or more years working in a clinical setting

Desired Experience (nice to have):

  • 2 or more years of Home Health Care experience
  • 2 or more years working in a Medicare Advantage health Plan

Required Knowledge, Skills & Abilities (must have):

  • Ability to complete assigned work in a timely and accurate manner
  • Knowledge of the Utilization management process
  • Ability to work independently

Desired Knowledge, Skills, Abilities & Language (nice to have):

  • Ability to apply predetermined criteria (e.g., Medical Necessity Guidelines, InterQual) to service decision requests to assess medical necessity
  • Flexibility and understanding of individualized care plans
  • Ability to influence decision making
  • Strong collaboration and negotiation skills
  • Strong interpersonal, verbal, and written communication skills
  • Comfort working in a team-based environment
  • Knowledge of Medicare and Mass health services and benefits

Salary: $35.00 - $40.00 Hourly pending experience.

Hours: Monday through Friday 9AM to 5:30PM Eastern Time. May require weekends

This is a fully remote work at home role. You must have a secure, private wok at home area with a hardwired internet connection with speeds greater than 5MB upload and 10MB download.

Sagility Offers Competitive Benefits Including:

  • Medical
  • Dental
  • Vision
  • Life Insurance
  • Short-Term and Long-Term Disability
  • Flexible Spending Account
  • Life Assistance Program
  • 401K with employer contribution
  • PTO and Sick Time
  • Tuition Reimbursement

Join our team, we look forward to talking with you!

An Equal Opportunity Employer/Vet/Disability

Location:

Work@Home USAUnited States of America

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