Senior Nurse Case Manager: Field & Remote Care Coordination

Blue Cross Blue Shield of Michigan; United States; Hybrid; USD 74,000 - 123,000; Full time

Job summary

Blue Cross Blue Shield of Michigan is seeking a Senior Nurse Case Manager within the Claims Department. The role applies medical expertise to review complex workers’ compensation claims, determine medical necessity, and facilitate return-to-work plans.

The SNCM may work telephonically or in-field, coordinating with providers, employers, and the claims team to implement cost-containment strategies. The Field SNCM Manager focuses on on-site coordination, timely care, and RTW facilitation for

Qualifications

• Active RN license required.
• BSN preferred.
• Five years of progressive responsibility in injury case management (workers’ compensation, etc.).
• Three years of RN clinical experience required.

Responsibilities

• Oversee assignments and contact all parties promptly.
• Review clinical status to determine causality and necessity of treatment.
• Negotiate with employers for early return to work or alternative duties.
• Coordinate with external nurse case management and document cost benefits.
• Apply medical knowledge to assess continued treatment and level of care.
• Mentor junior staff and contribute to monthly quality evaluations.

Skills

Negotiation

Communication

Attention to detail

Leadership

Problem solving

Time management

Education

RN license

BSN preferred

Tools

Microsoft Windows

Job description

Blue Cross Blue Shield of Michigan is seeking a Senior Nurse Case Manager within the Claims Department. The role applies medical expertise to review complex workers’ compensation claims, determine medical necessity, and facilitate return-to-work plans.

The SNCM may work telephonically or in-field, coordinating with providers, employers, and the claims team to implement cost-containment strategies. The Field SNCM Manager focuses on on-site coordination, timely care, and RTW facilitation for