Case Management Nurse at Blue Cross and Blue Shield of Kansas

This job was posted by https://www.kansasworks.com : For more

information, please see: https://www.kansasworks.com/jobs/13591284 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. Paid vacation and sick leave

with paid maternity and paternity available immediately upon hire

• Professional Growth Opportunities: Advance your career with

ongoing training and development programs.

• Dynamic Work Environment: Collaborate with a team of passionate

and driven individuals in a work environment that promotes

flexibility.

• Trust and Stability: Work for one of the most trusted companies

in Kansas with over 80 years of commitment, compassion and

community.

• Inclusive Work Environment: We pride ourselves on fostering a

workplace where everyone is valued and respected.

Benefits & Perks

• Base compensation is only one component of your competitive Total

• 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
• 401(k) plan matching up to 5%
• Tuition reimbursement
• Health & fitness benefits, discounts and resources

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 is eligible to work hybrid or onsite in accordance with

our Telecommuting Policy. Applicants must reside in Kansas or Missouri

or be willing to relocate as a condition of employment."

What you'll do

• Perform case management in compliance with URAC standards, CMS

and CCMC guidelines, ensuring accurate documentation, activity

monitoring, and audit reporting.

• Coordinate and communicate case management inquiries across

sales, provider relations, behavioral health vendors, and legal

counsel.

• Develop, implement, and monitor cost-effective treatment plans that

multiple providers and care settings, and negotiating reimbursement

when appropriate.

• Provide clinical support for precertification, case management, and

• Deliver onboarding, training, and guidance to new team members, and

involving patients, providers, caregivers, and facility

representatives.

• Maintain an appropriate caseload, ensuring timely documentation,

effectiveness.

What you need

Knowledge/Skills/Abilities

• Ability to communicate effectively, verbally, in writing and via

positive professional image.

• Ability to assess, analyze, plan, and evaluate situations.
• Ability to self-direct, make independent decisions, and prioritize

• Ability to handle sensitive situations in a positive, professional

• Must be comfortable discussing reimbursement/financial arrangements.
• Schedule could require alternative work hours, which may include

Education and Experience

Non-Certified

• Registered nurse with minimum three to five years clinical nursing

Nursing (BSN) preferred.

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

Registered nurse with minimum three to five years clinical nursing

experience, acute