Case Management Nurse
Blue Cross & Blue Shield of Kansas, Inc.
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Benefits offered by this job
Job summary
Blue Cross and Blue Shield of Kansas is seeking a Case Management Nurse – Non-Certified/Certified to oversee day-to-day case management activities, coordinate with providers, and negotiate reimbursements.
The role requires RN licensure in Kansas, CCM certification within two years, and a willingness to work hybrid or onsite in Kansas or Missouri. BSN preferred and government program experience is helpful.
Qualifications
- Ability to communicate effectively, verbally and in writing.
- Ability to assess, analyze, plan and evaluate situations.
- Ability to self-direct, make independent decisions and prioritize daily activities.
- Must be comfortable discussing reimbursement/financial arrangements.
- Schedule may include evenings, weekends, or 365 days availability.
Responsibilities
- Perform case management in compliance with URAC standards, CMS regulations, Kansas Nurse Practice Act, CMSA Standards of Practice, and CCMC guidelines.
- Coordinate case management inquiries across departments including medical directors, customer service, claims, provider relations, and legal counsel.
- Develop and monitor cost‑effective treatment plans spanning multiple providers and settings, negotiating reimbursement when appropriate.
- Provide clinical support for precertification, case management, and alternative care activities for commercial lines.
- Deliver onboarding, training, and guidance to new team members and participate in multidisciplinary meetings.
Skills
Education
Job description
Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.
Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
Family Comes First: Total rewards package that promotes the idea of family first for all employees.
Paid vacation and sick leave with paid maternity and paternity available immediately upon hire.
Professional Growth Opportunities: Advance your career with ongoing training and development programs.
Dynamic Work Environment: Collaborate with a team of passionate and driven individuals in a work environment that promotes flexibility.
Trust and Stability: Work for one of the most trusted companies in Kansas with over 80 years of commitment, compassion and community.
Inclusive Work Environment: We pride ourselves on fostering a workplace where everyone is valued and respected.
Base compensation is only one component of your competitive Total Rewards package.
- Incentive pay program (EPIP)
- Health/Vision/Dental insurance
- 6 weeks paid parental leave for new mothers and fathers
- Fertility/Adoption assistance
- 2 weeks paid caregiver leave
- 401(k) plan matching up to 5%
- Tuition reimbursement
- Health & fitness benefits, discounts and resources
The Case Management Nurse – Non-Certified/Certified is primarily and independently responsible for the day-to‑day operations of reviewing, processing, and communicating with members and providers involved in case management activities which may include determining appropriateness and cost effectiveness of care in light of quality‑of‑care objectives.
This position serves as primary negotiator with medical providers/vendors regarding reimbursement and provider write off of services involved in specific managed care cases.
Also carries primary responsibility for pre‑ and post‑case management claim payment. Provide backup support for precert activities. Responsible for performing all activities within State, URAC, HIPAA, DOL, CMS, and MTM goals or guidelines.
“This position is eligible to work hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.”
Perform case management in compliance with URAC standards, CMS regulations, Kansas Nurse Practice Act, CMSA Standards of Practice, and CCMC guidelines, ensuring accurate documentation, activity monitoring, and audit reporting.
Coordinate and communicate case management inquiries across departments, including medical directors, customer service, claims, sales, provider relations, behavioral health vendors, and legal counsel.
Develop, implement, and monitor cost‑effective treatment plans that meet patient needs and quality standards, coordinating care across multiple providers and care settings, and negotiating reimbursement when appropriate.
Provide clinical support for precertification, case management, and alternative care activities for commercial business lines.
Deliver onboarding, training, and guidance to new team members, and participate in multidisciplinary case management decision meetings involving patients, providers, caregivers, and facility representatives.
Maintain an appropriate caseload, ensuring timely documentation, follow‑up, and continuous evaluation of care plans for effectiveness.
Knowledge/Skills/Abilities Ability to communicate effectively, verbally, in writing and via telephone regarding sensitive and confidential issues and maintain a positive professional image.
Ability to assess, analyze, plan, and evaluate situations.
Ability to self‑direct, make independent decisions, and prioritize daily activities.
Ability to handle sensitive situations in a positive, professional manner.
Must be comfortable discussing reimbursement/financial arrangements.
Schedule could require alternative work hours, which may include evenings, weekends, availability 365 days per year.
Non‑Certified Registered nurse with minimum three years clinical nursing experience, acute medical/surgical preferred, Bachelor of Science in Nursing (BSN) preferred.
Current unrestricted Kansas RN license required.
Must become CCM certified within two years of assuming the position.
Experience with government programs is helpful.
Certified Registered nurse with minimum three years clinical nursing experience, acute medical/surgical preferred, Bachelor of Science in Nursing (BSN) preferred.
Current unrestricted Kansas RN license required.
Current unrestricted Certification as a case manager (CCM) required.
Experience with government programs is helpful.
90‑95% of daily activity requires use of computer and/or telephone.
$73,920 - $92,400 Exempt Grade 15 Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members.
The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid.
All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training.
The range may vary above or below the stated amounts.
At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace.
We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law.
Blue Cross and Blue Shield of Kansas conducts pre‑employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.
For more than 70 years, Blue Cross and Blue Shield of Kansas has built a reputation of trust.
As we move forward in this new era of health care we want to continue that tradition.
Whether a member needs Blue Cross to cover an annual check‑up or give them peace of mind during a major medical crisis, we want our members to know they can trust BCBSKS to meet their needs.
Our mission: Being the insurer Kansans trust with their health.
At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace.
We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law.
Blue Cross and Blue Shield of Kansas conducts pre‑employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.
For more than 70 years, Blue Cross and Blue Shield of Kansas has built a reputation of trust.
As we move forward in this new era of health care we want to continue that tradition.
Whether a member needs Blue Cross to cover an annual check‑up or give them peace of mind during a major medical crisis, we want our members to know they can trust BCBSKS to meet their needs.
Our mission: Being the insurer Kansans trust with their health.
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