<h3><b>To learn more about <a href="https://himalayas.app/companies/arkansas-blue-cross">Arkansas Blue Cross</a> and Blue Shield Hiring Policies, please click <a href="https://www.arkansasbluecross.com/company/career-opportunities/hiring-policies" rel="nofollow ugc noopener noreferrer" target="_blank">here</a>.</b></h3><h3>Job Summary</h3>The RN Case Manager plays a critical role in optimizing patient care and resource utilization. The incumbent is responsible for assessing, planning, implementing, coordinating, monitoring, and evaluating comprehensive care plans to meet individual health needs. This role focuses on quality patient outcomes and cost-effective healthcare delivery and may encompass general medical case management or specialize in high-acuity areas and/or high-cost areas such as high-risk obstetrics and neonatal care, chronic disease management, and/or mental health support (excludes Behavioral Health).<h3>Requirements</h3><h3>EDUCATION</h3><h3>Bachelor's degree in Nursing preferred.</h3><h3>LICENSING/CERTIFICATION</h3><p>Registered Nurse (RN) with current active state license in good standing in the state(s) where job duties are performed required.</p><p>Case management certification required. If certification is not obtained prior to employment, must obtain URAC recognized within three (3) years of hire as a RN Case Manager. The acceptable case management certifications are Certified Case Manager (CCM), Accredited Case Manager (ACM), and Registered Nurse - Board Certified (RN-BC).</p><h3>KNOWLEDGE &amp; EXPERIENCE</h3><p>Minimum four (4) years' clinical practice experience in at least one of the following areas: case management, home health, critical care, medical/surgical, discharge planning, concurrent review, or obstetric/neonatal care.</p><h3>ESSENTIAL ABILITIES &amp; SKILLS</h3><h3>Independence</h3><h3>Detail oriented</h3><h3>Skills</h3>• Administrative Process• Affinite CM• Affinite UM• CCI Edits• Collaborative Communications• Critical Reasoning• Cross-Functional Planning• Customer Relationship Management (CRM)• Customer Service Workstation• Deductive Reasoning• Five9• Information Security• Interpersonal Relationship Management• Microsoft Excel• Microsoft Office• Microsoft Outlook• Microsoft PowerPoint• Needs Assessment• Oral Communications• Problem Sensitivity• Researching• Sound Judgment• Support Coordination• Written Communication<h3>Responsibilities</h3>• Assesses, plans, implements, coordinates, monitors, and evaluates options and services required to meet an individual’s health needs through the use of plan benefits and community resources to facilitate appropriate cost effectiveness and cost containment measures are met.• Other duties as assigned.• Practices nursing within the scope of licensure and adheres to policies, procedures, regulations, URAC standards and individual state regulations and makes decisions based on facts and evidence to ensure compliance, appropriate level of care, and patient safety.• Provides s