Medicare Advantage Case Manager Nurse - Hybrid

Blue Cross and Blue Shield of Kansas; Topeka (KS); Hybride; USD 75 000 - 104 000; Plein temps

Avantages offerts par ce poste

Health insurance

Dental insurance

Vision insurance

6 weeks paid parental leave

Tuition reimbursement

401(k) with 5% match

Employee wellness programs

Résumé du poste

Blue Cross and Blue Shield of Kansas is seeking a Medicare Advantage Case Management Nurse (Non-Certified or Certified). This role reviews, processes, and communicates with members and providers for case management activities and negotiates reimbursement with providers.

Training is onsite for ~4 weeks with hybrid/onsite options after, and Kansas or Missouri residency is preferred. Responsibilities include URAC/CMS compliance, collaboration with multiple departments, and implementing

Qualifications

• RN with 3+ years clinical nursing experience, acute med/surg preferred.
• Current Kansas RN license required.
• CCM certification within 2 years of start date.
• Government program experience is helpful.

Responsabilités

• Perform case management in compliance with URAC, CMS, and CCMC guidelines; document activities and report audits.
• Coordinate case management inquiries across departments with medical directors, claims, and legal counsel.
• Develop cost-effective treatment plans, coordinate care, and negotiate reimbursement as needed.
• Provide clinical support for precertification and alternative care activities.
• Lead onboarding and training for new team members and participate in case management meetings.
• Maintain caseload, ensure timely documentation and follow-up.

Connaissances

Communication

Analysis

Decision making

Documentation

Collaboration

Time management

Reimbursement knowledge

Clinical nursing

Formation

RN license (KS)

BSN preferred

CCM certification within 2 years

Description du poste

Blue Cross and Blue Shield of Kansas is seeking a Medicare Advantage Case Management Nurse (Non-Certified or Certified). This role reviews, processes, and communicates with members and providers for case management activities and negotiates reimbursement with providers.

Training is onsite for ~4 weeks with hybrid/onsite options after, and Kansas or Missouri residency is preferred. Responsibilities include URAC/CMS compliance, collaboration with multiple departments, and implementing