Arkansas Blue Cross and Blue Shield · 1 hour ago
RN Case Manager
United States
Full-time
Remote
Mid Level
4+ years expArkansas Blue Cross and Blue Shield is seeking an RN Case Manager to optimize patient care and resource utilization. The role involves assessing, planning, implementing, coordinating, monitoring, and evaluating comprehensive care plans to meet individual health needs, focusing on quality patient outcomes and cost-effective healthcare delivery.
Financial ServicesHealth CareNon Profit
Responsibilities
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
Qualification
Required
Bachelor's degree in Nursing preferred
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)
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
Independence
Detail oriented
Company
Arkansas Blue Cross and Blue Shield
Arkansas Blue Cross and Blue Shield provides reliable insurance plans to Arkansans while being a valuable community partner.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Curtis Barnett
President and CEO
Recent News
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