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RN Case Manager
Arkansas Blue Cross and Blue Shield. Assess, plan, implement, coordinate, monitor, and evaluate options and services required to meet 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 coordination of healthcare services while ensuring compliance with regulations and standards. Proficient in liaising with various stakeholders and maintaining a patient caseload effectively.
Highest-signal resume keywords
Registered Nurse (RN) LicenseCase Management CertificationClinical Practice ExperienceKnowledge of Affinite CMDetail Oriented
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 ManagementPatient AssessmentHealthcare CoordinationDisease-Specific EducationCost Containment Strategies
Soft Skills
IndependenceCommunicationInterpersonal Skills
Tools & Technologies
Affinite CMAffinite UMCCI EditsFive9Microsoft ExcelMicrosoft OfficeMicrosoft OutlookMicrosoft PowerPoint
Certifications & Qualifications
Registered Nurse (RN)Certified Case Manager (CCM)Accredited Case Manager (ACM)Registered Nurse - Board Certified (RN-BC)
Industry Keywords
Healthcare Delivery TrendsURAC StandardsDischarge PlanningConcurrent ReviewHome Health
About the role
Key responsibilities & impact- Assess, plan, implement, coordinate, monitor, and evaluate options and services required to meet individual health needs
- Use plan benefits and community resources to support cost effectiveness and cost containment
- Practice nursing within the scope of licensure and comply with policies, regulations, URAC standards, and state regulations
- Provide specialized education on disease-specific conditions
- Maintain current knowledge of medical and surgical procedures, healthcare services, drugs, and healthcare delivery trends
- Liaise with patients, families/caregivers, physicians, hospital discharge planners, home care providers, and ancillary providers
- Proactively review referrals, identify case-management candidates, explain services, obtain voluntary agreement, and maintain a patient caseload
- Perform other duties as assigned
Requirements
What you’ll need- 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 not obtained prior to employment, must obtain URAC-recognized certification within three years of hire
- Acceptable case management certifications: Certified Case Manager (CCM), Accredited Case Manager (ACM), and 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
- Independence
- Detail oriented
- Work from home within Arkansas, Washington, Oregon, Utah, Idaho, North Dakota, or Minnesota
- Knowledge of listed systems and tools including Affinite CM, Affinite UM, CCI Edits, Five9, Microsoft Excel, Microsoft Office, Microsoft Outlook, and Microsoft PowerPoint