Case Management Nurse - Topeka - Blue Cross and Blue Shield of Kansas

Description

The Case Management Nurse – Non Certified/Certified, carries primary and independent responsibility for the day-to-day operations of reviewing, processing, and communicating with members and providers involved in case management activities which may include determining appropriateness and cost effectiveness of care in light of quality-of-care objectives. This position serves as primary negotiator with medical providers/vendors regarding reimbursement and provider write off of services involved in specific managed care cases. Also carries primary responsibility for pre and post-case management claim payment. Provide backup support for precert activities. Responsible for performing all activities within State, URAC, HIPAA, DOL, CMS, and MTM goals or guidelines.

"This position will be onsite 5 days/week through the 4–6-month training period. Once training is completed this position will be eligible to work onsite or hybrid (9 or more days a month on site) in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment."

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

Why Join Us

• Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
• Family Comes First: Total rewards package that promotes the idea of family first for all employees.
• Professional Growth Opportunities: Advance your career with ongoing training and development programs.
• Dynamic Work Environment: Collaborate with a team of passionate and driven individuals.
• Trust: Work for one of the most trusted companies in Kansas
• Stability: 80 years of commitment, compassion and community

Compensation

Exempt 15 - Non-Certified Case Management Nurse - $76,000 - $86,000 annually

Exempt 16 - Certified Case Management Nurse - $83,280 - $99,000 annually

• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.

What you'll do

• Manage and coordinate patient care in compliance with URAC standards, CMS regulations, Kansas Nurse Practice Act, CMSA Standards of Practice, and CCMC guidelines, ensuring accurate documentation, monitoring, and reporting.
• Develop, implement, and monitor cost-effective treatment plans that meet patient needs and quality standards, facilitating care transitions across the healthcare continuum and negotiating reimbursement when appropriate.
• Serve as the primary liaison for case management inquiries, collaborating with internal departments, providers, vendors, and legal counsel to ensure seamless communication and care coordination.
• Provide clinical support for precertification, case management, and alternative care for commercial lines of business.
• Lead onboarding and training for new team members, and participate in multidisciplinary decision-making with patients, providers, caregivers, and facility representatives.
• Maintain a balanced caseload, ensuring timely follow-up, documentation, and continuous evaluation of care plan effectiveness.

What you need

Knowledge/Skills/Abilities

• Ability to communicate effectively, verbally, in writing and via telephone regarding sensitive and confidential issues and maintain a positive professional image.
• Ability to assess, analyze, plan, and evaluate situations.
• Ability to self-direct, make independent decisions, and prioritize daily activities.
• Ability to handle sensitive situations in a positive, professional manner.
• Must be comfortable discussing reimbursement/financial arrangements.
• Schedule could require alternative work hours, which may include evenings, weekends, availability 365 days per year.

Education and Experience

• Non-Certified Case Management Nurse

• Registered nurse with minimum three to five years clinical nursing experience, acute medical/surgical preferred, Bachelor of Science in Nursing (BSN) preferred.

• Must have a current and unrestricted Kansas RN License.
• Must become CCM certified within two years of assuming the position.
• Experience with government programs is helpful.

• Certified Case Management Nurse

• Registered nurse with minimum three to five years clinical nursing experience, acute medical/surgical preferred, Bachelor of Science in Nursing (BSN) preferred.

• Must have a current and unrestricted Kansas RN License.
• Must have a current and unrestricted CCM certification.
• Experience with government programs is helpful.

Physical Requirements

• 85% of daily activity requires use of computer and/or telephone.

Benefits & Perks

• Base pay is only one component of your competitive Total Rewards package
• Incentive pay program (EPIP)
• Health/Vision/Dental insurance
• 6 weeks paid parental leave for new mothers and fathers
• Fertility/Adoption assistance
• 2 weeks paid caregiver leave
• 5% 401(k) plan matching
• Tuition reimbursement
• Health & fitness benefits, discounts and resources

Our Commitment to Connection and Belonging

At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law.

Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.