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Case Management Nurse at Blue Cross and Blue Shield of Kansas - ApplyBlast

Case Management Nurse

Blue Cross and Blue Shield of Kansas

4 months ago

3.4 on Glassdoor

Hybrid

Full Time

Senior

0 applicants

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About this role

A Case Management Nurse oversees day-to-day operations for reviewing, processing, and communicating medical case management activities to ensure cost-effective, high-quality care. The role involves negotiating with medical providers regarding reimbursement, managing claims payments, and developing treatment plans that meet quality objectives. Staff must comply with state regulations, URAC standards, and HIPAA guidelines while coordinating care across various providers and settings.

Responsibilities

Review and process complex medical case management activities daily
Negotiate reimbursement rates and provider write-offs with medical vendors
Develop and monitor cost-effective treatment plans for diverse patient needs
Coordinate care across multiple providers and various care settings
Ensure compliance with state regulations and URAC accreditation standards

Skills

Qualifications

Bachelor of Science in Nursing (BSN)Kansas RN LicenseCCM CertificationRegistered Nurse

About Blue Cross and Blue Shield of Kansas

bcbsks.com

Headquarters

Topeka, Kansas, United States

Company Size

1001-5000 employees

Founded

1942

View Profile

Health insurance and dental plans, related health care benefits for Medicare, individual or group health insurance. Manage your health care choices with BCBSKS.