RN Case Manager

Arkansas Blue Cross Blue Shield • Arkansas Remote, AR

1d • $73,045 - $92,723

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 meet individual health needs. The role focuses on quality patient outcomes and cost-effective healthcare delivery. Work may involve general medical case management or specialization in high-acuity or high-cost areas, such as high-risk obstetrics and neonatal care, chronic disease management, and mental health support (excluding Behavioral Health).

The position practices nursing within the scope of licensure and follows applicable policies, procedures, regulations, URAC standards, and state regulations. It facilitates collaboration among patients, families and caregivers, physicians, hospital discharge planners, home care providers, and other ancillary providers to promote quality, accessible, appropriate, and cost-effective care. The role also includes identifying candidates for case management, explaining services, securing voluntary agreement to participate, and maintaining a minimum patient caseload.

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, obtain a URAC-recognized certification within three years of hire as a 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 and attention to detail.
• Skills in administrative process, Affinite CM, Affinite UM, CCI Edits, collaborative communications, critical reasoning, cross-functional planning, customer relationship management (CRM), Customer Service Workstation, deductive reasoning, Five9, information security, interpersonal relationship management, Microsoft Excel, Microsoft Office, Microsoft Outlook, Microsoft PowerPoint, needs assessment, oral communications, problem sensitivity, researching, sound judgment, support coordination, and written communication.

Nice To Haves

• Bachelor's degree in Nursing preferred.

Responsibilities

• Assess, plan, implement, coordinate, monitor, and evaluate options and services needed to meet individual health needs, using plan benefits and community resources to support cost effectiveness and cost containment.
• Perform other duties as assigned.
• Practice nursing within the scope of licensure and adhere to policies, procedures, regulations, URAC standards, and individual state regulations; make fact- and evidence-based decisions to support compliance, appropriate levels of care, and patient safety.
• Provide specialized education and disease-specific knowledge as needed and assigned.
• Stay current on medical and surgical procedures, products, healthcare services and drugs, healthcare delivery trends, enterprise procedures, policies, and contracts.
• Serve as a liaison and facilitate collaboration among patients, families and caregivers, physicians, hospital discharge planners, home care providers, and other ancillary providers to promote quality of care, cost effectiveness, accessibility, and appropriate service levels.
• Proactively work 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level