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RN Case Manager
Arkansas Blue Cross and Blue Shield. Assess, plan, implement, coordinate, monitor, and evaluate comprehensive care plans and services 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 implementation of comprehensive care plans while ensuring compliance with URAC standards. Proficient in utilizing community resources and healthcare delivery trends to enhance patient care and cost-effectiveness.
Highest-signal resume keywords
Registered Nurse (RN)Case Management CertificationClinical Practice ExperienceKnowledge of Administrative ProcessPatient Safety Compliance
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Comprehensive Care PlanningPatient AssessmentDisease-Specific EducationDischarge PlanningConcurrent ReviewHome Health ManagementCritical Care KnowledgeNeeds AssessmentSupport CoordinationInformation Security
Soft Skills
IndependenceDetail OrientationCommunicationLiaison SkillsProactive Problem Solving
Tools & Technologies
Affinite CMAffinite UMCCI EditsFive9Microsoft ExcelMicrosoft OfficeMicrosoft OutlookMicrosoft PowerPointCRM
Certifications & Qualifications
Registered Nurse (RN) LicenseCertified Case Manager (CCM)Accredited Case Manager (ACM)Registered Nurse - Board Certified (RN-BC)
Industry Keywords
Case ManagementHealthcare Delivery TrendsPatient SafetyCost ContainmentVoluntary Agreement
About the role
Key responsibilities & impact- Assess, plan, implement, coordinate, monitor, and evaluate comprehensive care plans and services to meet individual health needs
- Use plan benefits and community resources to facilitate cost effectiveness and cost containment
- Practice nursing within the scope of licensure while ensuring compliance, appropriate level of care, and patient safety
- 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, ensure 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
- 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 as an RN Case Manager
- Acceptable case management 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
- Knowledge of Administrative Process, Affinite CM, Affinite UM, CCI Edits, Five9, Microsoft Excel, Microsoft Office, Microsoft Outlook, and Microsoft PowerPoint
- Knowledge of information security, needs assessment, support coordination, CRM, and researching
- Independence and detail orientation
- Must practice nursing within scope of licensure and comply with URAC standards and applicable state regulations
Benefits
Comp & perks- Remote work arrangement
- Regular employment