RN Case Manager

🕒 August 28

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 28%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Arkansas Blue Cross and Blue Shield

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1948

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Arkansas Blue Cross and Blue Shield is a health insurance provider licensed to offer health plans in all 75 counties of Arkansas. The company offers a wide range of insurance products including individual and family plans, Medicare and Medigap plans, dental and vision plans, as well as health plans for travelers and employer group plans. They provide members with personalized services such as health management through the Blueprint Portal, where users can manage their health plan, review claims, find healthcare providers, and estimate treatment costs. Arkansas Blue Cross and Blue Shield is an independent licensee of the Blue Cross and Blue Shield Association.

📋 Description

• Assess, plan, implement, coordinate, monitor, and evaluate comprehensive care plans, options, and services to meet individual health needs • Use plan benefits and community resources to support 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 and knowledge on disease-specific conditions • Stay current with medical and surgical procedures, healthcare products and services, 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 • Work proactively with referrals to identify appropriate case-management candidates, explain services, obtain voluntary agreement, and maintain a minimum patient caseload • Perform other duties as assigned

🎯 Requirements

• 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 • 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 • Independence • Detail oriented • Skills in administrative processes, Affinite CM, Affinite UM, CCI Edits, collaborative communications, critical reasoning, cross-functional planning, customer relationship management, 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 • Must adhere to state regulations, URAC standards, company policies and procedures, security/confidentiality requirements, and segregation-of-duties guidelines