RN Case Manager

BCBSM, Inc.; United States; Remote; USD 69,000 - 114,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401k

PTO

VPTO

Job summary

Blue Cross and Blue Shield of Minnesota is seeking a teleworker case manager to provide telephonic assessments, identify gaps in care, and develop individualized care plans for members with behavioral health needs.

This role coordinates referrals, updates case documentation, and collaborates with providers, Member Services, and clinical teams to ensure timely, appropriate support while safeguarding privacy.

Qualifications

• 3+ years of related case management (clinical) professional experience.
• RN licensure required or equivalent professional credentials.
• Bachelor’s degree or equivalent experience considered.

Responsibilities

• Provide telephonic engagement to assess needs and document findings.
• Coordinate referrals and connect members to in-network resources.
• Develop and monitor individualized care plans with follow-up goals.
• Review member information and prepare for outreach calls.
• Participate in clinical rounds and team meetings to ensure best practices.
• Maintain privacy and collaborate with Member Services on complex cases.

Skills

Case management

Clinical experience

RN licensure

Flexible hours

Education

Bachelor's degree

Job description

About Blue Cross and Blue Shield of Minnesota

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us.

The Impact You'll Have

Provides telephonic support to members with behavioral health needs by conducting assessments, identifying gaps in care, and developing individualized care plans. This role coordinates referrals, connects members to community and in-network providers, and helps members understand their benefits, ensuring comprehensive support without delivering direct clinical care.

What You'll Do

• Provide telephonic engagement only, using motivational interviewing and therapeutic techniques to encourage participation.
• Manage a mix of new cases and follow-up calls, ensuring timely and effective support.
• Develop and monitor individualized care plans, setting follow-up actions and goals.
• Navigate multiple systems to gather relevant information and update case documentation.

How You'll Do It

• Review member information and prepare for outreach calls to conduct clinical assessments and document findings.
• Research, place referrals and coordinate with providers to connect members to appropriate resources and services, following up to ensure receipt and follow through.
• Participate in clinical rounds and team meetings to review cases, receive feedback, and ensure best practices.
• Prepare for and present cases during client or vendor audits, defending actions taken and responding to inquiries.
• Navigate complex member situations, including privacy issues due to family dynamics, by collaborating with Member Services to resolve concerns while maintaining ongoing support for the member.
• Consult with team members to ensure best practices, participate in required training, and assist with specialty projects; frequently mentor and provide shadowing opportunities for new hires.
• Performs additional responsibilities consistent with the scope and level of the role, as assigned.

Required Skills & Experience

• 3+ years of related case management (clinical) professional experience.
• Bachelor's degree; in lieu of a degree, an additional two years of relevant experience beyond the qualifications listed above may be accepted.
• Flexibility to work varied hours.

Preferred Skills & Experience

• Ability to tailor communication to varied audiences, actively listen to uncover requirements, and ensure accurate and timely information exchange.
• Ability to analyze information, identify patterns and root causes, and collaborate with partners to implement practical solutions.
• Ability to leverage technology to tailor communications to varied audiences, listen to uncover needs, analyze root causes, and collaborate on practical solutions.
• Ability to effectively organize work, balance competing priorities, and manage time across multiple responsibilities and deadlines.

Licensure/Certifications Required

• Registered Nurse (RN) - State Nursing Licensing Board
• Temporary Registered Nurse (RN) - State Nursing Licensing Board

Role Designation

• Teleworker: Teleworking is working full time remote.
• Hybrid: a minimum of 2 days onsite.
• Onsite: full-time onsite.

Compensation and Benefits

$68,900.00 - $91,300.00 - $113,700.00 Annual Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.

• Medical, dental, and vision insurance
• Life insurance
• 401k
• Paid Time Off (PTO)
• Volunteer Paid Time Off (VPTO)
• And more

Equal Employment Opportunity Statement

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life.

Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affiiative Action plan, as required by Minnesota law applicable to state contractors.

All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic.

Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: [e-mail].

Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.

Physical requirements.

Chartered in 1933 as Minnesota's first health plan, this company is one of the most recognized and trusted healthcare brands in the world. It has more members, the largest network of doctors, and more products and services than any other health plan in Minnesota. Headquartered in Eagan, Minnesota.