Remote RN Case Manager

Arkansas Blue Cross and Blue Shield; Little Rock (AR); On-site; USD 65,000 - 90,000; Full time

Job summary

Arkansas Blue Cross and Blue Shield is seeking an RN Case Manager to optimize patient care and resource utilization. The role focuses on assessing, planning, implementing, coordinating, monitoring and evaluating comprehensive care plans to meet individual health needs.

The position requires a current RN license in good standing, a certified case manager credential (CCM/ACM or RN-BC) or URAC certification within three years, and a bachelor's degree in nursing preferred.

Qualifications

• RN license with current active state license in good standing; case management certification required.
• If certification is not obtained prior to employment, URAC recognized within three years of hire as an RN Case Manager.
• Acceptable certifications: CCM, ACM, or RN-BC.

Responsibilities

• Assess, plan, implement, coordinate, monitor, and evaluate care for individuals using plan benefits and community resources.
• Other duties as assigned.
• Practice nursing within licensure and adhere to policies, URAC standards and state regulations to ensure patient safety and appropriate level of care.
• Provide education on disease-specific conditions as needed.
• Stay current with medical procedures, products, services and contracts.
• Serve as liaison among patients, families, physicians, hospital discharge planners and home care providers to promote quality and cost-effectiveness.

Skills

Administrative Process

Affinite CM

Affinite UM

CCI Edits

Collaborative Communications

Critical Reasoning

Cross-Functional Planning

Customer Relationship Management (CRM)

Customer Service Workstation

Deductive Reasoning

Five9

Information Security

Interpersonal Relationship Management

Microsoft Excel

Microsoft Office

Microsoft Outlook

Microsoft PowerPoint

Needs Assessment

Oral Communications

Problem Sensitivity

Researching

Sound Judgment

Support Coordination

Written Communication

Education

Bachelor's degree in Nursing

Tools

Five9

Customer Relationship Management (CRM)

Microsoft Excel

Microsoft Office

Microsoft Outlook

Microsoft PowerPoint

Job description

Arkansas Blue Cross and Blue Shield is seeking an RN Case Manager to optimize patient care and resource utilization. The role focuses on assessing, planning, implementing, coordinating, monitoring and evaluating comprehensive care plans to meet individual health needs.

The position requires a current RN license in good standing, a certified case manager credential (CCM/ACM or RN-BC) or URAC certification within three years, and a bachelor's degree in nursing preferred.