Case Management Nurse: Clinical Navigator & Care Coordinator

Blue Cross and Blue Shield of Kansas; Topeka (KS); Hybrid; USD 74,000 - 92,000; Full time

Benefits offered by this job

Hybrid work options

Job summary

Blue Cross and Blue Shield of Kansas seeks a Case Management Nurse – Non-Certified/Certified to manage day-to-day case reviews, negotiate with providers, and oversee precertification activities. The role requires RN background and CCM certification within two years.

This position can be hybrid or onsite under our Telecommuting Policy, and applicants must reside in Kansas or Missouri or be willing to relocate.

Qualifications

• 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.

Responsibilities

• 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.

Skills

Communication skills

Analytical thinking

Self-direction

Handling sensitive issues

Reimbursement discussions

Flexible schedule

Education

Bachelor of Science in Nursing (BSN) preferred

Current unrestricted Kansas RN license

CCM certification within two years

Job description

Blue Cross and Blue Shield of Kansas seeks a Case Management Nurse – Non-Certified/Certified to manage day-to-day case reviews, negotiate with providers, and oversee precertification activities. The role requires RN background and CCM certification within two years.

This position can be hybrid or onsite under our Telecommuting Policy, and applicants must reside in Kansas or Missouri or be willing to relocate.