• Job Description

  Req#: R0013011

  To learn more about Arkansas Blue Cross and Blue Shield Hiring Policies, please click here.

  Applicants must be eligible to begin work on the date of hire. Applicants must be currently authorized to work in the United States on a full-time basis. ARKANSAS BLUE CROSS BLUE SHIELD will NOT sponsor applicants for work visas in this position.

  Arkansas Blue Cross is only seeking applicants for remote positions from the following states:

  Arkansas, Florida, Georgia, Illinois, Kansas, Louisiana, Minnesota, Mississippi, Oklahoma, South Carolina, Tennessee, Texas, Virginia and Wisconsin.

  Job Summary

  RN Case Manager uses a collaborative process of assessment, planning, implementing, coordinating, monitoring and evaluating options and services required to meet an individual's health needs through communication and available resources to promote quality and cost effective outcomes. Case management may cover general health concerns or specialized care areas such as high cost/high risk obstetric and neonatal or chronic conditions such as diabetes, hypertension, congestive heart failure, asthma, chronic obstructive pulmonary disease, and/or depression (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. Acceptable case management certifications are CCM, ACM, and RN-BC.

  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 SKILLS & ABILITIES
  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.

  Skills

  Active Listening Administrative Process Affinite CM Affinite UM CCI Edits Collaborative Communications Computer Literacy Critical Reasoning Critical Thinking Cross-Functional Planning Customer Relationship Management (CRM) Deductive Reasoning Five9 Health Insurance Portability & Accountability Act (HIPAA) Information Ordering Information Security Interpersonal Relationship Management Medical Care Microsoft Excel Microsoft Office Microsoft Outlook Microsoft PowerPoint Needs Assessment Oral Communications Problem Sensitivity Psychology Researching Sociology Sound Judgment Speech Clarity Speech Recognition Support Coordination Written Communication

  Responsibilities

  • Case Management (Excludes Behavioral Health): 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. • Communication: 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. • Compliance: 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. • Education: May be required to provide specialized education and knowledge on disease specific conditions. • Knowledge: 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. • Other duties as assigned. • Workflow: 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 matter.

  Certifications

  Registered Nurse (RN) - Arkansas State Board of Nursing

  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

  Regular

  ADA 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.

• About the company

  Founded in 1948, Arkansas Blue Cross and Blue Shield, an Independent Licensee of the Blue Cross and Blue Shield Association, is the largest health insurer in Arkansas. Arkansas Blue Cross and its family of affiliated companies have more than 3,200 employees.

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