Remote RN Case Manager: Care Coordination

Arkansas Blue Cross Blue Shield; North Dakota; Remote; USD 73,000 - 93,000; Full time

Job summary

Arkansas Blue Cross Blue Shield seeks an RN Case Manager to optimize patient care and resource use. The role monitors, evaluates, and coordinates care plans across settings to ensure quality outcomes and cost containment.

Requirements include an active RN license, case management certification (or URAC within 3 years), and at least four years of clinical practice in CM, home health, critical care, or obstetric/neonatal care.

Qualifications

• RN with active state license in good standing in the state(s) where duties are performed required.
• Case management certification required. If certification not obtained prior to employment, must obtain URAC recognized within three (3) years of hire as a RN Case Manager.
• Minimum four (4) years' clinical practice experience in case management, home health, critical care, medical/surgical, discharge planning, concurrent review, or obstetric/neonatal care.

Responsibilities

• Assesses, plans, implements, coordinates, monitors, and evaluates options and services required to meet an individual’s health needs through the use of plan benefits and community resources to facilitate appropriate cost effectiveness and cost containment measures are met.
• Other duties as assigned.
• Practices nursing within the scope of licensure and adheres to policies, procedures, regulations, URAC standards and individual state regulations and makes decisions based on facts and evidence to ensure compliance, appropriate level of care, and patient safety.
• Provides specialized education and knowledge on disease specific conditions as needed and assigned.
• Remains current with up-to-date medical and surgical procedures, products, healthcare services and drugs, general trends in health care delivery, enterprise procedures, policies and contracts.
• Serves as a liaison facilitating a collaborate process which includes patients, families/caregivers, physicians, hospital discharger planners, home care providers and other ancillary providers to promote quality of care, cost effectiveness, accessibility and appropriateness of service levels.
• Works proactively with referrals from multiple sources to identify appropriate candidates for case management, explains services ensuring voluntary agreement of services and maintains a minimum patient caseload in a timely matter.

Skills

Administrative Process

Affinite CM

Affinite UM

CCI Edits

Collaborative Communications

Critical Reasoning

Cross-Functional Planning

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

CRM

Five9

Microsoft Excel

Microsoft Office

Microsoft Outlook

Microsoft PowerPoint

Information Security

Job description

Arkansas Blue Cross Blue Shield seeks an RN Case Manager to optimize patient care and resource use. The role monitors, evaluates, and coordinates care plans across settings to ensure quality outcomes and cost containment.

Requirements include an active RN license, case management certification (or URAC within 3 years), and at least four years of clinical practice in CM, home health, critical care, or obstetric/neonatal care.