Remote RN Care Coordinator, Case Management & Member Support

Blue Cross and Blue Shield of Alabama; Birmingham (AL); Remote; USD 65,000 - 90,000; Full time

Job summary

Blue Cross and Blue Shield of Alabama seeks a Registered Nurse to lead member management programs. You will coordinate case activities, assess member needs, and craft alternative treatment plans to maximize contract benefits.

The role emphasizes clear communication with providers, subscribers, and groups. Requirements include an active RN license, Alabama or multi-state licensure, and a willingness to obtain Case Management certification within two years.

Qualifications

• Bachelor’s Degree or upon hire commit to actively pursue a degree.
• Active License in good standing as a Registered Nurse (RN).
• Multi-State licensure as a Registered Nurse allowing practice in Alabama or Alabama licensure, and upon hire, agree to pursue licensure in other States as applicable.
• Willingness to attain Case Management certification within 2 years of hire date.
• Minimum of three years of clinical experience in medical/surgical health care fields, a psychiatric, and/or an obstetrical setting.
• Effective verbal and written communication skills with providers, subscribers and group representatives.
• Experience analyzing clinical situations and making informed decisions in an autonomous setting.
• Experience interpreting and communicating information orally and in writing with all levels of staff internal and external.
• Experience in a position requiring independent decision-making skills.
• Experience making informed decisions in an autonomous setting.
• Willingness to work a flexible schedule to provide telephone coverage.
• Willingness to travel up to 10% of the time as needed.
• Experience in a position using negotiation skills preferred.
• Experience in a position presenting information in formal and informal settings preferred.
• Knowledgeable of benefit guidelines, claims payment guidelines, billing guidelines, laws and contracts governing health insurance programs.
• Experience in OR, ICU, Med Surg, or Dialysis specialties preferred.
• Experience in Home Health and/or Case Management preferred.

Responsibilities

• Develop, coordinate, and administer activities related to Member Management Programs.
• Communicate effectively with members of the health care delivery system and group representatives.
• Coordinate case activity and maximize member contract benefits by evaluating needs and developing alternative plans of treatment.

Skills

RN license

Case management

Communication skills

Independent decision-making

Travel readiness

Education

Bachelor’s Degree or pursuing degree

Job description

Blue Cross and Blue Shield of Alabama seeks a Registered Nurse to lead member management programs. You will coordinate case activities, assess member needs, and craft alternative treatment plans to maximize contract benefits.

The role emphasizes clear communication with providers, subscribers, and groups. Requirements include an active RN license, Alabama or multi-state licensure, and a willingness to obtain Case Management certification within two years.