Health Care and Network Management

Our Health Care and Network Management teams help Blue Cross NC keep costs low for our members. They find maintain good relationships with the doctors in our network and set policies to make sure members get the best price on prescriptions and procedures.

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Interpreting and Applying Medical Policy

Our Health Care team reviews requests for medical services and prescription drugs. They use their expert clinical judgement to determine benefit coverage for these services and prescriptions based on the member's needs, the member's plan and Blue Cross NC medical policies.

Coordinating Members' Care and Services

When doctors, specialists, clinics and hospitals communicate well it improves the patient's experience and outcome. That's why our Health Care team helps coordinate the care our members get from their doctors and specialists. We make sure everyone is focused on the member's health.

Ensuring Effective Use of Health Care Resources

We help keep health care costs down by making sure health care resources are used efficiently and effectively. Our team monitors how those resources are being used, always looking for new ways to be more efficient and improve members' health.

Managing Our Relationships with Doctors and Hospitals

We take pride in our networks of high quality doctors, hospitals and clinics. When you join our Network Management team, you'll work with providers to design new models for reimbursement, as well as complex contract negotiations. You'll help us stay competitive in the health care market. Your strategic understanding of the need for constant improvement will help you enhance our relationships with providers.

Improving How Patient Care Works

At the heart of our relationships with doctors is how patients get their care. We're working with doctors and hospitals to improve patient experiences and make them seamless from the first call to a doctor to the last treatment.

Helping Us Keep Costs Low

We're always looking for new and creative ways to keep health care costs low. Our team is finding better ways to pay claims and keep administrative fees low. We're also working directly with doctors and hospitals to control costs.


Blue Cross NC On-site Service

Blue Cross and Blue Shield of North Carolina's on-site representatives are working directly with hospitals and patients to answer claims and benefit questions, improve quality of care and reduce wasted costs.


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