Remote Case Management Nurse I

Santa Barbara Cottage Hospital; United States; Remote; USD 70,000 - 95,000; Full time

Job summary

Wellmark Blue Cross Blue Shield is seeking a Case Management Nurse I to actively engage with members, creating individualized care plans and coordinating care with providers and community resources. This remote-eligible role supports members with chronic and complex health care needs and requires strong communication and documentation skills.

Preferred candidates are located in Iowa or South Dakota with prior health plan exposure; you'll obtain CCM within 24 months of hire and maintain

Qualifications

• Completion of an accredited nursing program.
• Active and unrestricted RN license in home state.
• Certified Case Manager (CCM) must be obtained within 24 months of hire.
• Strong verbal and written communication; accurate documentation.
• Ability to manage multiple priorities in a dynamic environment.
• Knowledge of URAC, NCQA, HIPAA and PHI confidentiality.
• Experience in utilization management or health insurance is beneficial.

Responsibilities

• Must be flexible to work weekends and/or holiday hours on a rotational basis.
• Identify high-risk and complex conditions to plan care and navigate the health care system.
• Discuss care needs with members and plan interventions.
• Coordinate with members, families, providers and community resources to arrange services.
• Document care management activities accurately in the care management system.

Skills

Verbal communication

Written communication

Time management

Multitasking

Tech savviness

Independent decision making

Resourceful

Education

Registered Nurse (RN) license

Accredited nursing program

Certified Case Manager (CCM)

Tools

Microsoft Office

Outlook

Excel

Teams

Job description

Wellmark Blue Cross Blue Shield is seeking a Case Management Nurse I to actively engage with members, creating individualized care plans and coordinating care with providers and community resources. This remote-eligible role supports members with chronic and complex health care needs and requires strong communication and documentation skills.

Preferred candidates are located in Iowa or South Dakota with prior health plan exposure; you'll obtain CCM within 24 months of hire and maintain