RN Case Manager

🕒 Setembro 14

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $73.045 - $92.722 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

👻 Score fantasma 39%

O que significa: a chance de ninguém estar realmente contratando para esta vaga.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Por que essa pontuação:

• Aberta há 59 dias.
• As vagas desta empresa costumam ser preenchidas em 21 dias.
• Repostada uma vez.

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Arkansas Blue Cross and Blue Shield

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 1948

🏥 Saúde

🛡️ Seguros

⚕️ Seguro de Saúde

Healthcare • Insurance • Healthcare Insurance

Arkansas Blue Cross and Blue Shield é uma empresa de seguro saúde licenciada para oferecer planos de saúde em todos os 75 condados do Arkansas. A empresa oferece uma ampla gama de produtos de seguro, incluindo planos individuais e familiares, planos Medicare e Medigap, planos odontológicos e oftalmológicos, além de planos de saúde para viajantes e planos para grupos empresariais. Eles fornecem aos membros serviços personalizados, como gerenciamento de saúde através do Portal Blueprint, onde os usuários podem gerenciar seu plano de saúde, revisar reivindicações, encontrar prestadores de saúde e estimar custos de tratamento. Arkansas Blue Cross and Blue Shield é licenciado independentemente pela Blue Cross and Blue Shield Association.

Descrição

• Assess, plan, implement, coordinate, monitor, and evaluate options and services required to meet individual health needs using plan benefits and community resources, ensuring cost effectiveness and cost containment. • Practice nursing within the scope of licensure and adhere to policies, procedures, regulations, URAC standards, and state regulations. • Make decisions based on facts and evidence to ensure compliance, appropriate level of care, and patient safety. • Provide specialized education and knowledge on disease-specific conditions as needed and assigned. • Remain current with medical and surgical procedures, products, healthcare services and drugs, healthcare delivery trends, enterprise procedures, policies, and contracts. • Serve as a liaison among patients, families/caregivers, physicians, hospital discharge planners, home care providers, and ancillary providers to promote quality, cost effectiveness, accessibility, and appropriate service levels. • Work proactively with referrals to identify case-management candidates, explain services, obtain voluntary agreement, and maintain a minimum patient caseload in a timely manner. • Perform other duties as assigned.

🎯 Requisitos

• Bachelor's degree in Nursing preferred. • 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 not obtained prior to employment, must obtain URAC recognized certification within three (3) years of hire as a RN Case Manager. • Acceptable case management certifications: Certified Case Manager (CCM), Accredited Case Manager (ACM), and Registered Nurse - Board Certified (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. • Independence. • Detail oriented. • Skills in Administrative Process, Affinite CM, Affinite UM, CCI Edits, Collaborative Communications, Critical Reasoning, Cross-Functional Planning, Customer Relationship Management (CRM), Customer Service Workstation, Deductive Reasoning, Five9, Information Security, Interpersonal Relationship Management, Microsoft Excel, Microsoft Office, Microsoft Outlook, Microsoft PowerPoint, Needs Assessment, Oral Communications, Problem Sensitivity, Researching, Sound Judgment, Support Coordination, and Written Communication.

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