Remote RN Case Manager: Care Coordination & Outcomes

Arkansas Blue Cross; Arkansas; On-site; USD 60,000 - 80,000; Full time

Job summary

Arkansas Blue Cross is seeking an experienced RN Case Manager to optimize patient care and resource utilization. The role involves assessing, planning, implementing, coordinating, monitoring, and evaluating comprehensive care plans across care settings.

The ideal candidate has a nursing degree, an active RN license, and 4+ years in case management or related areas, with URAC-recognized certifications within 3 years if not already held. Strong communication and coordination skills are essential.

Qualifications

• Bachelor's degree in Nursing preferred.
• RN license in good standing in the state(s) where duties are performed required.
• Case management certification required; URAC recognition within 3 years if not obtained prior to employment (CCM, ACM, RN-BC).
• 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

• Assess, plan, implement, coordinate, monitor, and evaluate care options to meet health needs within plan benefits and community resources.
• Adhere to policies, URAC standards, and state regulations to ensure safe, appropriate care.
• Provide disease-specific education and up-to-date medical knowledge to patients and families.
• Coordinate with physicians, discharge planners, home care providers, and other stakeholders to ensure quality, cost-effective care.
• Maintain a caseload and manage referrals to optimize resource use and outcomes.
• Follow segregation of duties and enterprise procedures to ensure compliance.

Skills

Independence

Detail oriented

Critical Reasoning

Cross-Functional Planning

Oral Communications

Written Communication

Needs Assessment

Microsoft Excel

CRM

Customer Service Workstation

Education

Bachelor's degree in Nursing

RN license in good standing

Case management Certification (CCM/ACM/RN-BC)

Job description

Arkansas Blue Cross is seeking an experienced RN Case Manager to optimize patient care and resource utilization. The role involves assessing, planning, implementing, coordinating, monitoring, and evaluating comprehensive care plans across care settings.

The ideal candidate has a nursing degree, an active RN license, and 4+ years in case management or related areas, with URAC-recognized certifications within 3 years if not already held. Strong communication and coordination skills are essential.