RN Case Manager

Arkansas Blue Cross and Blue Shield; Little Rock (AR); Remote; USD 63,000 - 89,000; Full time

Job summary

A prominent health insurance provider seeks an RN Case Manager to optimize patient care through assessment and coordination of services. This pivotal role requires a blend of clinical expertise in case management and strong communication skills to ensure quality outcomes. Candidates must possess an active RN license and relevant certifications, with a preference for those with considerable nursing experience. Opportunities for ongoing professional development are also available.

Qualifications

• Registered Nurse (RN) with current active state license required.
• Case management certification required within three years.
• Minimum four years' clinical practice experience in relevant fields.

Responsibilities

• Assesses, plans, implements, coordinates, and evaluates health needs.
• Facilitates collaboration among patients, caregivers, and providers.
• Ensures compliance with nursing policies, regulations, and safety measures.

Skills

Excellent oral & written communication skills

Detail-Oriented

Proficiency in basic computer skills

Ability to make sound judgments

Ability to build collaborative relationships

Education

Bachelor's degree in Nursing

Tools

Microsoft Office

Job description

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To learn more about Arkansas Blue Cross and Blue Shield Hiring Policies, please click here.
Applicants must be eligible to begin work on the date of hire. Applicants must be currently authorized to work in the United States on a full-time basis. ARKANSAS BLUE CROSS BLUE SHIELD will NOT sponsor applicants for work visas in this position.
Arkansas Blue Cross is only seeking applicants for remote positions from the following states:

Arkansas, Florida, Georgia, Illinois, Kansas, Louisiana, Minnesota, Mississippi, Oklahoma, South Carolina, Tennessee, Texas, Virginia and Wisconsin.

Job Summary

RN Case Manager uses a collaborative process of assessment, planning, implementing, coordinating, monitoring and evaluating options and services required to meet an individual's health needs through communication and available resources to promote quality and cost effective outcomes. Case management may cover general health concerns or specialized care areas such as high cost/high risk obstetric and neonatal or chronic conditions such as diabetes, hypertension, congestive heart failure, asthma, chronic obstructive pulmonary disease, and/or depression (Excludes Behavioral Health).

Requirements


EDUCATION
Bachelor's degree in Nursing preferred.

LICENSING/CERTIFICATION
Registered Nurse (RN) with current active state license in good standing in the state(s) where job duties are performed required.
Case management certification required. If certification is not obtained prior to employment, must obtain URAC recognized within three (3) years of hire as a RN Case Manager. Acceptable case management certifications are CCM, ACM, and RN-BC.

Experience

Minimum four (4) years' clinical practice experience in at least one of the following areas: case management, home health, critical care, medical/surgical, discharge planning, concurrent review, or obstetric/neonatal care.

Essential Skills & Abilities

Excellent oral & written communication skills
Detail-Oriented
Proficiency using basic computer skills in Microsoft Office such as Word, Excel, and Outlook, including the ability to navigate multiple systems and keyboarding.
Ability to make sound judgements and decisions based on facts and guidelines.
Ability to build collaborative relationships.
Ability to interpret complex documentation.
Ability to work independently with little supervision.

Skills

Active Listening Administrative Process Affinite CM Affinite UM CCI Edits Collaborative Communications Computer Literacy Critical Reasoning Critical Thinking Cross-Functional Planning Customer Relationship Management (CRM) Deductive Reasoning Five9 Health Insurance Portability & Accountability Act (HIPAA) Information Ordering Information Security Interpersonal Relationship Management Medical Care Microsoft Excel Microsoft Office Microsoft Outlook Microsoft PowerPoint Needs Assessment Oral Communications Problem Sensitivity Psychology Researching Sociology Sound Judgment Speech Clarity Speech Recognition Support Coordination Written Communication

Responsibilities

• Case Management (Excludes Behavioral Health): 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.
• Communication: 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.
• Compliance: Practices nursing within the scope of licensure and adheres to policies, procedures, regulations, URAC standards and individual state regulations; making decisions based on facts and evidence to ensure compliance, appropriate level of care, and patient safety.
• Education: May be required to provide specialized education and knowledge on disease specific conditions.
• Knowledge: Remain current with up-to-date medical and surgical procedures, products, healthcare services and drugs, general trends in health care delivery; and enterprise procedures, policies and contracts.
• Other duties as assigned.
• Workflow: Proactively work with referrals from multiple sources to identify appropriate candidates for case management, explaining services ensuring voluntary agreement of services and maintaining a minimum patient caseload in a timely matter.
  
  

Certifications
Registered Nurse (RN) - Arkansas State Board of Nursing
Security Requirements
This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.
Segregation of Duties
Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.
Employment Type
Regular

ADA Requirements

2.1 General Office Worker, Semi-Active, Campus Travel - Someone who normally works in an office setting or remotely, periodically has lifting and carrying requirements up to 40 lbs and routinely travels for work within walking distance of location of primary work assignment as essential functions of the job.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Insurance

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