RN Case Manager

🔥 1 hour ago

🥔 Idaho, North Dakota, +4 more states – Remote

🥔 Idaho – Remote 🌾 North Dakota – Remote 🌲 Oregon – Remote ❄️ Minnesota – Remote ⛷️ Utah – Remote ☕ Washington – Remote

💵 $73k - $92.7k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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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 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 and make evidence-based decisions to ensure compliance, appropriate level of care, and patient safety. • Provide specialized education on disease-specific conditions as needed. • Remain current with medical and surgical procedures, healthcare 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 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 (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. • Work from home within Arkansas, Washington, Oregon, Utah, Idaho, North Dakota, or Minnesota. • Must adhere to policies, procedures, regulations, URAC standards, and individual state regulations. • Must ensure the security and confidentiality of records and information. • Must adhere to segregation of duties guidelines.

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