Case Management Nurse I

🔥 0 minutes ago

🗿 South Dakota – Remote

🗿 South Dakota – 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 • Use critical thinking to identify high-risk and complex conditions and anticipate member needs • Discuss care needs using supportive interventions and effective planning techniques • Identify barriers and gaps to care and ensure appropriate care, communication, education, and avoidance of duplicated services • Engage members in care management plans and educate them on accountabilities, outcomes, benefits, and services • Research evolving resources and programs and collaborate with Wellmark stakeholders • Facilitate referrals to providers, community resources, programs, 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 they reside • 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 and problem-solving skills • Knowledge of resources, processes, and guidelines • Ability to make independent decisions or recommendations under ambiguity • Ability to organize and manage multiple priorities • Timeliness, follow-up, accuracy, and attention to detail • Flexibility and adaptability to change • Strong technical acumen and ability to learn new systems quickly • Microsoft Office proficiency, including Outlook, Excel, and Teams • Knowledge of URAC, NCQA, HIPAA, and PHI confidentiality standards and regulations • Flexibility to work weekend and/or holiday hours rotationally when needed • Ability to provide high-speed internet at the work location • Must not require immigration sponsorship or additional/permanent work authorization 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 • Responsible use of AI supported and encouraged • Equal opportunity employment • Reasonable accommodations during the employment application process