RN Case Manager
| Company | Arkansas Blue Cross |
|---|---|
| Location | Little Rock, AR, USA |
| Salary | $Not Provided – $Not Provided |
| Type | Full-Time |
| Degrees | Bachelor’s |
| Experience Level | Mid Level, Senior |
Requirements
- 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. Acceptable case management certifications are CCM, ACM, and 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.
- Excellent oral & written communication skills
- Detail-Oriented
- Proficiency using basic computer skills in Microsoft Office such as Word, Excel, and Outlook, including the ability to navigate multiple systems and keyboarding.
- Ability to make sound judgements and decisions based on facts and guidelines.
- Ability to build collaborative relationships.
- Ability to interpret complex documentation.
- Ability to work independently with little supervision.
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.
- Serves as a liaison facilitating a collaborative 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.
- Practices nursing within the scope of licensure and adheres to policies, procedures, regulations, URAC standards and individual state regulations; making decisions based on facts and evidence to ensure compliance, appropriate level of care, and patient safety.
- May be required to provide specialized education and knowledge on disease specific conditions.
- Remain current with up-to-date medical and surgical procedures, products, healthcare services and drugs, general trends in health care delivery; and enterprise procedures, policies and contracts.
- Proactively work with referrals from multiple sources to identify appropriate candidates for case management, explaining services ensuring voluntary agreement of services and maintaining a minimum patient caseload in a timely manner.
Preferred Qualifications
-
No preferred qualifications provided.