Medical and Behavioral Case Manager (RN)

Job Summary

Are you an RN with Case Management experience looking to enhance your career? Join BCBSND as a Medical Behavioral Case Manager focusing on Behavioral Health or Medical Case Management within Medicaid Expansion. The Medical and Behavioral Case Manager reviews cases of members with acute or chronic conditions and collaborates with service providers, the patient and family, and internal resources (e.g. Medical Review) to establish the most effective treatment plan within the provisions of the policy. This position screens, assesses and develops case recommendations, educates patients and family, coordinates with providers and monitors and documents case(s) on an ongoing basis.

This opportunity is eligible for internal and external applicants. This role is eligible for remote work or a hybrid work arrangement. We empower our employees to find a work style that is best for them.  Click Life at Blue | BCBSND to learn more.

Pay level: 022

FLSA category: Exempt - Salaried

Essential Functions

• Identifies and assesses members with acute or chronic conditions for possible case management (CM) intervention. Develops, coordinates and monitors a plan of care for members with case management needs and educates both member and health care team of services allowed within the benefit plan.
• Develops a case management plan of care by initiating contact with the member/designated representative and their health care provider team after obtaining case management program consent from the member. Assesses initial and ongoing needs with the member/family, health care team and case manager by completing a thorough assessment of medical records and contact with providers and patient.
• Collaborates in identifying appropriate alternatives to the present care and providing assistance with identified needs by collaborating with the member and member’s health care team.
• Participates in discharge planning, networking with appropriate outside agencies and making appropriate referrals to alternative resources as needed.
• Documents case information and practices per CM policy and procedures and in accordance with CM accreditation standards.
• Verifies member benefit eligibility for alternative care for medical necessity and appropriateness and initiates the request for service.
• Throughout the case management process, collaborates with internal and external medical, utilization management and customer services teams as needed in the collaboration and coordination of the member’s care.

 

Knowledge, Skills and Abilities

Clinical Expertise

Advanced

Effective Interpersonal Communications

Advanced

Decision Making

Intermediate

Flexibility and Adaptability

Intermediate

Collaboration

Intermediate

Education Requirements

Required: Associate's

Preferred: Bachelor's

Field(s) of Study: Completion of RN program is required; BSN is highly preferred

 

Experience Requirements

Required: Minimum of 3 Years

Preferred: Minimum of 5 Years

Experience Details: Minimum of 3 years of clinical or related experience is required; previous case management experience is highly desirable.

 

Certification, Licensures & Registration Requirements

Title: North Dakota (ND) Registered Nurse (RN) License or RN License valid for work in ND

 

 

State or Agency: Board of Nursing

 

Equivalent combination of education, experience or training determined to be acceptable by Human Resources may be substituted, unless regulated by contract or program standards

 

Physical Demands

 

Sitting

Frequent (60-90%)

Use of Computer

Frequent (60-90%)

Telephones and Other Electronic Devices

Frequent (60-90%)

Talking

Frequent (60-90%)

Other Information

Job Posting Policy

Employees new to Blue Cross Blue Shield of North Dakota are eligible to apply for positions within their assigned department after successfully completing 90-days in their role. For positions outside of their department, new employees should attain a minimum of six months of service before applying for a new role. Exceptions to this are acceptable, provided there is good business justification for making the move.

Equal Opportunity Employment

Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individual with Disabilities, as well as Sexual Orientation or Gender Identity.

For questions, please email careers@bcbsnd.com

This job posting will be closed 8/19/2022 at 8:00AM CST. No further applications will be considered.