RN Case Manager

🔥 5 minutes 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 comprehensive care plans, options, and services to meet individual health needs • Use plan benefits and community resources to promote 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 and knowledge on disease-specific conditions as needed • Remain current on 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 • Work proactively with referrals to identify appropriate case-management candidates, explain services, obtain voluntary agreement, and maintain a timely minimum patient caseload • Perform other duties as assigned

🎯 Requirements

• Bachelor's degree in Nursing preferred • Current active Registered Nurse (RN) 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 as an RN Case Manager • Acceptable 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, Information Security, Microsoft Excel, Microsoft Office, Microsoft Outlook, and Microsoft PowerPoint • Skills in collaborative communications, critical reasoning, cross-functional planning, customer relationship management, customer service workstation, deductive reasoning, interpersonal relationship management, needs assessment, oral communications, problem sensitivity, researching, sound judgment, support coordination, and written communication • Must adhere to applicable policies, procedures, regulations, URAC standards, and individual state regulations • Must maintain security and confidentiality of records and information • Must adhere to segregation of duties guidelines

🏖️ Benefits

• Remote work arrangement • Campus travel within walking distance of the primary work assignment • Regular employment