Medical and Behavioral Case Manager RN

Blue Cross Blue Shield North Dakota•Fargo, ND

16h•$66,500 - $90,000•Remote

About The Position

You likely know us as an insurance company, but that’s just a portion of what we do. Hundreds of thousands of North Dakotans trust us to provide them with personalized service and unmatched access to care. It’s a mission we take seriously. We also work with entities throughout the state to challenge the cost and complexity of health care in North Dakota. This uncompromising goal requires caring, innovative people who are ready and willing to help create a new level of health and well-being in North Dakota and beyond. Our Strategic Affiliation with Cambia In 2026, BCBSND and Cambia Health Solutions formed a strategic affiliation to enhance access to simpler, more affordable health care while keeping a strong local focus. The affiliation was approved by North Dakota regulators and became effective Feb. 1, 2026. Under this affiliation, BCBSND employees became Cambia employees while continuing to serve the BCBSND market. Dayâtoâday work and hiring continue as usual. The Medical and Behavioral Case Manager RN is responsible for reviewing cases of members with acute or chronic conditions and collaborates with service providers, the patient and family, and internal resources to establish the most effective treatment plan within the provisions of the policy. This position screens, assesses and develops case recommendations, educates patients and family, coordinates with providers and monitors and documents case(s) on an ongoing basis.

Requirements

An associates degree and completion of RN program is required.
3 years of experience in clinical or related experience.
North Dakota (ND) Registered Nurse (RN) License or RN License valid for work in ND is required.
Advanced clinical expertise with the ability to apply complex clinical concepts and make informed recommendations.
Advanced interpersonal communication skills with the ability to engage effectively and respectfully with members, caregivers, providers, and team members.
Strong decisionâmaking skills with the ability to evaluate information, assess options, and make sound judgments within scope.
Ability to adapt to changing priorities, member needs, and workflows while maintaining effectiveness and professionalism.
Effective collaboration skills with the ability to work seamlessly across teams, departments, and external partners.
Equivalent combination of education, experience or training determined to be acceptable by Human Resources may be substituted, unless regulated by contract or program standards

Nice To Haves

BSN is strongly preferred.
Previous case management experience is preferred.

Responsibilities

Identifies and assesses members with acute or chronic conditions for possible case management (CM) intervention.
Develops, coordinates, and monitors a plan of care for members with case management needs and educates both member and health care team of services allowed within the benefit plan.
Develops a case management plan of care by initiating contact with the member/designated representative and their health care provider team after obtaining case management program consent from the member.
Assesses initial and ongoing needs with the member/family, health care team and case manager by completing a thorough assessment of medical records and contact with providers and patient.
Collaborates in identifying appropriate alternatives to the present care and aiding with identified needs by collaborating with the member and member's health care team.
Participates in discharge planning, networking with appropriate outside agencies and making appropriate referrals to alternative resources as needed.
Documents case information and practices per CM policy and procedures and in accordance with CM accreditation standards.
Verifies member benefit eligibility for alternative care for medical necessity and appropriateness and initiates the request for service.
Collaborates with internal and external medical, utilization management and customer services teams as needed in the collaboration and coordination of the member's care throughout the case management process.

Benefits

Affordable medical, dental and vision coverage accepted throughout the United States
Employer funded Lifestyle Spending Accounts and Health Savings Accounts.
Voluntary employee contributions to Health Savings Accounts and Flexible Spending Accounts
Employer-paid life and disability insurance
401(k) retirement plan with company match and immediate vesting
Paid holidays, paid time off (PTO), PTO donation program, and paid parental leave
Voluntary benefits including Accident, Hospital Indemnity, Critical Illness, Term/Whole Life, Cancer Care Insurance, and more.
Additional company perks
Robust mental health offerings including an Employee Assistance Program, Learn to Live, meQ.
Comprehensive learning and development opportunities and an Educational Assistance Program.
16 hours of paid volunteer time with a $200 donation to a charity of your choice upon completion of all volunteer hours.
Employee recognition, community initiative events and yearly company outings.
Workplace flexibility offering different options for working arrangements and the freedom to make time for important commitments.
Opportunities to connect through employee committees.