Case Management Nurse I

🔥 0 minutes ago

🌾 Iowa – Remote

🌾 Iowa – Remote

⏳ Contract/Temporary

🟡 Mid-level

🟠 Senior

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Wellmark Blue Cross and Blue Shield

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1939

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Wellmark Blue Cross and Blue Shield is a health insurance provider operating primarily in Iowa and South Dakota. The company offers a range of health insurance plans including individual and family plans, Medicare Advantage, Medicare Supplement, and employer group plans. Wellmark emphasizes providing coverage options that meet diverse needs and budgets, and offers resources for managing accounts, payments, and health care access through their online portal, myWellmark. Additionally, Wellmark provides resources for providers, employers, and producers to drive business efficiency and quality in health care services.

📋 Description

• Engage members through multiple channels to support chronic and/or complex health care needs • Create and manage individualized care plans • Partner with members, families, health care providers, and community resources to coordinate care and services • Use critical thinking to identify high-risk and complex conditions and anticipate member needs • Discuss care needs through supportive interventions and planning techniques • Identify barriers and gaps to care and facilitate appropriate services and referrals • Educate members about accountabilities, expected outcomes, benefits, and services • Research evolving resources and programs and collaborate with Wellmark stakeholders • Document care management activities accurately, consistently, and timely using relevant technology • Comply with regulatory, accreditation, and internal standards • Work weekend and/or holiday hours on a rotational basis when needed • Perform other duties as assigned

🎯 Requirements

• Completion of an accredited nursing program • Active and unrestricted RN license in Iowa or South Dakota; must be licensed in the state of residence • Certified Case Manager (CCM), to be obtained within 24 months of hire and maintained throughout the position • 4+ years of diverse clinical experience, including 4+ years of direct clinical care to consumers • Care navigation/care coordination experience strongly preferred • Behavioral health experience preferred • Prior health plan experience preferred • Experience in utilization management or a health insurance setting beneficial • Strong verbal and written communication skills • Accurate documentation in case management platforms • Critical thinking, problem-solving, independent decision-making, and ability to manage ambiguity • Ability to organize and manage multiple priorities in a dynamic environment • Strong technical acumen, including Microsoft Office, clinical documentation platforms, and learning new systems • Knowledge of URAC, NCQA, HIPAA, and PHI confidentiality standards and regulations • Flexibility to work weekend and/or holiday hours on a rotational basis when needed • High-speed internet at the remote work location • Applicants must not require immigration sponsorship or additional/permanent work authorization in the United States

🏖️ Benefits

• Fully remote work eligibility • Flexibility to work where you are most productive • Option to come into a Wellmark office depending on location • Responsible use of AI supported for the workforce and job seekers • Reasonable accommodation support during the application process