Senior Nurse Case Manager - Field & Care Coordination

Blue Cross Blue Shield of Michigan; Knoxville (TN); Hybrid; USD 74,000 - 123,000; Full time

Job summary

Blue Cross Blue Shield of Michigan seeks a Senior Nurse Case Manager (SNCM) in the Claims Department to support strategic initiatives and review complex workers' compensation claims for return-to-work readiness. The role may be field-based or hybrid, with on-site interactions and coordination with providers and employers.

Ideal candidates hold an active RN license, a BSN preferred, and have several years of experience in injury case management, with strong negotiation, communication, and

Qualifications

• RN license active and unrestricted required.
• BSN preferred.

Responsibilities

• Oversee new assignments and make timely initial contacts with all parties.
• Review patient clinical status and history to determine causal nature of symptoms related to work injuries.
• Complete RN template and documentation, including medical history and exposure analysis with cost drivers.
• Negotiate and coordinate with employer for early return to work or alternative duty.
• Oversee external nurse case management and external RN task assignments with documented strategy and cost benefit.
• Apply medical knowledge during contacts with physicians and therapists on cases with prolonged treatment.
• Determine medical necessity/reasonableness of proposed ongoing treatment and hospitalization decisions.

Skills

Negotiation skills

Communication

Leadership

Time management

Problem solving

Teamwork

Analytical skills

Attention to detail

Education

Registered Nurse license

BSN preferred

Tools

Microsoft Windows

Job description

Blue Cross Blue Shield of Michigan seeks a Senior Nurse Case Manager (SNCM) in the Claims Department to support strategic initiatives and review complex workers' compensation claims for return-to-work readiness. The role may be field-based or hybrid, with on-site interactions and coordination with providers and employers.

Ideal candidates hold an active RN license, a BSN preferred, and have several years of experience in injury case management, with strong negotiation, communication, and