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RN Case Manager
Arkansas Blue Cross and Blue Shield. Assess, plan, implement, coordinate, monitor, and evaluate comprehensive care options and services for individual health needs .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in case management, including assessment, planning, and implementation of comprehensive care options while adhering to URAC standards and state regulations. Proficient in utilizing healthcare delivery trends and maintaining effective communication among patients, families, and healthcare providers.
Highest-signal resume keywords
Registered Nurse (RN) LicenseCase Management CertificationClinical Practice ExperienceKnowledge of URAC StandardsSkills in Administrative Processes
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Case ManagementNeeds AssessmentCritical ReasoningDeductive ReasoningHealthcare Delivery TrendsMedical Procedures KnowledgeSurgical Procedures KnowledgeHealthcare Products KnowledgeCost ContainmentPatient Caseload Management
Soft Skills
Written CommunicationOral CommunicationCoordinationLiaison SkillsProactive Problem Solving
Tools & Technologies
Affinite CMAffinite UMFive9Microsoft ExcelMicrosoft OfficeMicrosoft OutlookMicrosoft PowerPointCRM
Certifications & Qualifications
Registered Nurse - Board Certified (RN-BC)Certified Case Manager (CCM)Accredited Case Manager (ACM)
Industry Keywords
URAC StandardsState RegulationsHealthcare ServicesDischarge PlanningHome HealthCritical CareMedical/Surgical CareObstetric CareConcurrent ReviewPatient Confidentiality
About the role
Key responsibilities & impact- Assess, plan, implement, coordinate, monitor, and evaluate comprehensive care options and services for individual health needs
- Use plan benefits and community resources to promote cost effectiveness and cost containment
- Practice nursing within the scope of licensure and comply with policies, procedures, regulations, URAC standards, and state regulations
- Provide specialized education on disease-specific conditions
- Maintain current knowledge of medical and surgical procedures, healthcare products and services, drugs, and healthcare delivery trends
- 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 case-management services, obtain voluntary agreement, and maintain a minimum patient caseload in a timely manner
- Perform other duties as assigned
Requirements
What you’ll need- Bachelor's degree in Nursing preferred
- Current active Registered Nurse (RN) state license in good standing in the state(s) where job duties are performed required
- Case management certification required; if not obtained before employment, must obtain a URAC-recognized certification 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
- Knowledge of URAC standards, state regulations, healthcare services, medical and surgical procedures, products, drugs, healthcare delivery trends, policies, and contracts
- Skills in administrative processes, Affinite CM, Affinite UM, CCI Edits, Five9, Microsoft Excel, Microsoft Office, Microsoft Outlook, Microsoft PowerPoint, CRM, needs assessment, support coordination, critical reasoning, deductive reasoning, information security, and written and oral communication
- Must maintain security and confidentiality of records and information
- Must adhere to segregation of duties guidelines
Benefits
Comp & perks- Remote work arrangement
- Campus travel within walking distance of the primary work assignment
- Regular employment