RN Case Manager
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Job Description
RN Case Manager coordinating comprehensive care plans and specialized healthcare support. Improving patient outcomes and cost-effective care for Arkansas Blue Cross and Blue Shield.
Responsibilities:
- Assess, plan, implement, coordinate, monitor, and evaluate options and services to meet individual health needs using plan benefits and community resources
- Facilitate cost effectiveness and cost containment measures
- Practice nursing within the scope of licensure and ensure compliance, appropriate level of care, and patient safety
- Provide specialized education and knowledge on disease-specific conditions
- Maintain current knowledge of medical and surgical procedures, products, healthcare services, drugs, healthcare delivery trends, enterprise procedures, policies, and contracts
- Serve as a liaison among patients, families/caregivers, physicians, hospital discharge planners, home care providers, and ancillary providers
- Work proactively with referrals to identify appropriate case management candidates, explain services, obtain voluntary agreement, and maintain a minimum patient caseload
- Perform other duties as assigned
Requirements:
- Bachelor's degree in Nursing preferred
- Current active Registered Nurse (RN) license in good standing in the state(s) where job duties are performed required
- Case management certification required; if not obtained before employment, URAC-recognized certification must be obtained within three years of hire
- Acceptable certifications: Certified Case Manager (CCM), Accredited Case Manager (ACM), or Registered Nurse–Board Certified (RN-BC)
- Minimum four years of clinical practice experience in case management, home health, critical care, medical/surgical, discharge planning, concurrent review, or obstetric/neonatal care
- Ability to practice nursing within the scope of licensure and comply with policies, regulations, URAC standards, and state regulations
- Ability to maintain security and confidentiality of records and information
- Ability to adhere to segregation of duties guidelines
- 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
Benefits:
- Remote work arrangement
- Regular employment
- Campus travel within walking distance of the primary work assignment
- Up to 40 lbs lifting and carrying allowance as part of job requirements
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