RN Case Manager
At a glance
Manager-level role at Arkansas Blue Cross. Remote, United States · full-time · $73,045–$92,722 base.
remoteroles summary, based on the employer's posting.
What you'll do
- Build and review individual care plans, coordinating plan benefits and community resources to meet health needs and manage costs
- Connect patients, caregivers, physicians and care providers to support appropriate, accessible care
- Identify suitable case management referrals, explain the service and secure voluntary participation while managing a patient caseload
- Use evidence and nursing standards to support patient safety, compliance and appropriate levels of care
- Provide condition-specific guidance and stay current on treatments, services and medicines relevant to your assigned work
What you bring
- You hold an active RN license in good standing wherever you perform the work
- You have case management certification, or can earn a URAC-recognized credential within three years of starting
- You bring at least four years of clinical practice in case management, home health, critical care or another listed area
Who this fits
This remote role suits an RN who can work independently and handle detailed care coordination. You may manage general medical cases or work in areas such as high-risk obstetrics, neonatal care or chronic disease. Work travel includes routine trips within walking distance of your primary assignment; the role may involve lifting or carrying up to forty pounds.
From the employer
To learn more about Arkansas Blue Cross and Blue Shield Hiring Policies, please click here.
Job Summary
The RN Case Manager plays a critical role in optimizing patient care and resource utilization. The incumbent is responsible for assessing, planning, implementing, coordinating, monitoring, and evaluating comprehensive care plans to meet individual health needs. This role focuses on quality patient outcomes and cost-effective healthcare delivery and may encompass general medical case management or specialize in high-acuity areas and/or high-cost areas such as high-risk obstetrics and neonatal care, chronic disease management, and/or mental health support (excludes Behavioral Health).Requirements
EDUCATION
Bachelor's degree in Nursing preferred.
LICENSING/CERTIFICATION
Registered Nurse (RN) with current active state license in good standing in the state(s) where job duties are performed required.
Case management certification required. If certification is not obtained prior to employment, must obtain URAC recognized within three (3) years of hire as a RN Case Manager. The acceptable case management certifications are Certified Case Manager (CCM), Accredited Case Manager (ACM), and Registered Nurse - Board Certified (RN-BC).
KNOWLEDGE & EXPERIENCE
Minimum four (4) years' clinical practice experience in at least one of the following areas: case management, home health, critical care, medical/surgical, discharge planning, concurrent review, or obstetric/neonatal care.
ESSENTIAL ABILITIES & SKILLS
Independence
Detail oriented
Skills
• 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
• Written CommunicationResponsibilities
• Assesses, plans, implements, coordinates, monitors, and evaluates options and services required to meet an individual’s health needs through the use of plan benefits and community resources to facilitate appropriate cost effectiveness and cost containment measures are met.
• Other duties as assigned.
• Practices nursing within the scope of licensure and adheres to policies, procedures, regulations, URAC standards and individual state regulations and makes decisions based on facts and evidence to ensure compliance, appropriate level of care, and patient safety.
• Provides specialized education and knowledge on disease specific conditions as needed and assigned.
• Remains current with up-to-date medical and surgical procedures, products, healthcare services and drugs, general trends in health care delivery, enterprise procedures, policies and contracts.
• Serves as a liaison facilitating a collaborate process which includes patients, families/caregivers, physicians, hospital discharger planners, home care providers and other ancillary providers to promote quality of care, cost effectiveness, accessibility and appropriateness of service levels.
• Works proactively with referrals from multiple sources to identify appropriate candidates for case management, explains services ensuring voluntary agreement of services and maintains a minimum patient caseload in a timely matter.Certifications
Accredited Case Manager (ACM) - American Case Management Association (ACMA), Certified Case Manager (CCM) - The Commission for Case Manager Certification (CCMC), Registered Nurse (RN) - Arkansas State Board of NursingHiring Range
$73,045.00 - $92,722.50
Security Requirements
This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.
Segregation of Duties
Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.
Employment Type
RegularADA Requirements
2.1 General Office Worker, Semi-Active, Campus Travel - Someone who normally works in an office setting or remotely, periodically has lifting and carrying requirements up to 40 lbs and routinely travels for work within walking distance of location of primary work assignment as essential functions of the job.
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