Case Management Nurse I

🔥 0 minutes ago

🌾 Iowa – Remote

🌾 Iowa – Remote

⏳ Contract/Temporary

🟡 Mid-level

🟠 Senior

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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 • Recognize high-risk and complex conditions and anticipate member needs • Discuss care needs using supportive interventions and planning techniques • Identify barriers and gaps to care and prevent duplication of services • Educate members about benefits, services, accountabilities, and expected outcomes • Research resources and programs as science and technology evolve • Collaborate with internal and external clinical and nonclinical stakeholders • Facilitate referrals to providers, community resources, and Wellmark programs • Document care management activities accurately, consistently, and timely using relevant technology tools • 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 in which the individual resides • Certified Case Manager (CCM); must obtain within 24 months of hire and maintain 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 communication and written documentation skills • Critical thinking and problem-solving skills • Ability to make independent decisions or recommendations under ambiguity • Ability to organize and manage multiple priorities in a dynamic environment • Strong technical acumen, including Microsoft Office and clinical documentation platforms • Knowledge of URAC, NCQA, HIPAA, and PHI confidentiality standards • Flexibility to work rotational weekend and/or holiday hours when needed • Must provide high-speed internet at the work location • Must not require immigration sponsorship or additional/permanent work authorization sponsorship now or in the future to work in the United States

🏖️ Benefits

• Fully remote work eligibility • Option to work from a Wellmark office depending on location • High-speed internet provided by the candidate at their work location • Opportunity to use responsible AI tools in the workforce and application process