RN Case Manager

🕒 il y a 8 jours

🇺🇸 États-Unis – Télétravail

⏰ Temps Plein

🟡 Intermédiaire

🟠 Senior

👔 Manager

👻 Score fantôme 12%

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🗣️🇺🇸🇬🇧 Anglais requis

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Logo of Arkansas Blue Cross and Blue Shield

Arkansas Blue Cross and Blue Shield

1001 - 5000 employés

Fondée en 1948

🏥 Santé

🛡️ Assurance

⚕️ Assurance santé

Healthcare • Insurance • Healthcare Insurance

Arkansas Blue Cross and Blue Shield est un fournisseur d'assurance santé agréé pour offrir des plans de santé dans les 75 comtés de l'Arkansas. L'entreprise propose une large gamme de produits d'assurance incluant des plans individuels et familiaux, des plans Medicare et Medigap, des plans dentaires et optiques, ainsi que des plans de santé pour les voyageurs et des plans pour les groupes d'employeurs. Ils fournissent à leurs membres des services personnalisés tels que la gestion de la santé via le portail Blueprint, où les utilisateurs peuvent gérer leur plan de santé, consulter les réclamations, trouver des prestataires de santé et estimer les coûts des traitements. Arkansas Blue Cross and Blue Shield est un licencié indépendant de l'association Blue Cross and Blue Shield.

Description

• Assess, plan, implement, coordinate, monitor, and evaluate comprehensive care plans and services to meet individual health needs • Use plan benefits and community resources to facilitate cost effectiveness and cost containment • Practice nursing within the scope of licensure while ensuring compliance, appropriate level of care, and patient safety • Provide specialized education on disease-specific conditions • Maintain current knowledge of medical and surgical procedures, healthcare products and services, drugs, and healthcare delivery trends • Serve as a liaison among patients, families/caregivers, physicians, hospital discharge planners, home care providers, and ancillary providers • Work proactively with referrals to identify appropriate case management candidates • Explain case management services, ensure voluntary agreement, and maintain a minimum patient caseload in a timely manner • Perform other duties as assigned

🎯 Exigences

• 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 years of hire as an RN Case Manager • Acceptable case management certifications: Certified Case Manager (CCM), Accredited Case Manager (ACM), or Registered Nurse - Board Certified (RN-BC) • Minimum four years of clinical practice experience in case management, home health, critical care, medical/surgical, discharge planning, concurrent review, or obstetric/neonatal care • Knowledge of Administrative Process, Affinite CM, Affinite UM, CCI Edits, Five9, Microsoft Excel, Microsoft Office, Microsoft Outlook, and Microsoft PowerPoint • Knowledge of information security, needs assessment, support coordination, CRM, and researching • Independence and detail orientation • Must practice nursing within scope of licensure and comply with URAC standards and applicable state regulations

🏖️ Avantages

• Remote work arrangement • Regular employment

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