RN Case Manager

Arkansas Blue Cross Blue Shield • Washington, DC

1d • $73,045 - $92,723 • Remote

About The Position

The RN Case Manager optimizes patient care and resource utilization by assessing, planning, implementing, coordinating, monitoring, and evaluating comprehensive care plans that address individual health needs. The role focuses on quality patient outcomes and cost-effective healthcare delivery. Case management may be general medical or may specialize in high-acuity or high-cost areas, including high-risk obstetrics and neonatal care, chronic disease management, and mental health support (excluding Behavioral Health).

The position works from home within Arkansas, Washington, Oregon, Utah, Idaho, North Dakota, or Minnesota. Preference is given to current employees and candidates residing in Arkansas, Utah, Idaho, and North Dakota. The hiring range is $73,045.00–$92,722.50. This is a regular position with level-three security requirements concerning the confidentiality and integrity of records and information. The employee must also follow segregation-of-duties guidelines.

Requirements

• Current, active Registered Nurse (RN) license in good standing in the state or states where job duties are performed.
• Case management certification is required. If not obtained before employment, an URAC-recognized certification must be obtained within three years of hire as an RN Case Manager. Accepted certifications are Certified Case Manager (CCM), Accredited Case Manager (ACM), and Registered Nurse–Board Certified (RN-BC).
• At least four years of clinical practice experience in one or more of these areas: case management, home health, critical care, medical/surgical, discharge planning, concurrent review, or obstetric/neonatal care.
• Independence.
• Attention to detail.

Nice To Haves

• Bachelor's degree in Nursing preferred.

Responsibilities

• Assess, plan, implement, coordinate, monitor, and evaluate options and services needed to meet individuals’ health needs, using plan benefits and community resources to support cost effectiveness and cost containment.
• Practice nursing within the scope of licensure and adhere to policies, procedures, regulations, URAC standards, and applicable state regulations; make evidence-based decisions that support compliance, appropriate levels of care, and patient safety.
• Provide specialized education and knowledge on disease-specific conditions as needed and assigned.
• Stay current on medical and surgical procedures, products, healthcare services and drugs, healthcare delivery trends, and enterprise procedures, policies, and contracts.
• Serve as a liaison among patients, families or caregivers, physicians, hospital discharge planners, home care providers, and other ancillary providers to promote quality, cost-effective, accessible, and appropriate care.
• Work proactively with referrals from multiple sources to identify appropriate case-management candidates, explain services, obtain voluntary agreement to services, and maintain a minimum patient caseload in a timely manner.
• Perform other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed