RN Case Manager

🔥 12 hours ago

🇺🇸 United States – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 12%

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 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 and comply with policies, procedures, regulations, URAC standards, and state regulations • Make evidence-based decisions to ensure compliance, appropriate level of care, and patient safety • Provide specialized education on disease-specific conditions as needed • Stay current with medical and surgical procedures, products, 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 • Promote quality of care, cost effectiveness, accessibility, and appropriate service levels • Work proactively with referrals to identify candidates for case management • Explain services, ensure voluntary agreement, and maintain a minimum patient caseload in a timely manner • 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 a 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 (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 • 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 • Written Communication • Must adhere to security and confidentiality requirements • Must adhere to segregation of duties guidelines

🏖️ Benefits

• Remote work arrangement • Regular employment • Campus travel provisions, including lifting and carrying up to 40 lbs