Medical Case Manager

5 days ago


Topeka, Kansas, United States Blue Cross and Blue Shield Association Full time
Job Overview

In this role as a Medicare Advantage Case Management Triage Nurse, you will play a vital part in the day-to-day operations of reviewing, processing, and communicating with members and providers involved in case management activities. This position requires strong analytical skills to determine the appropriateness and cost-effectiveness of care in light of quality-of-care objectives.

As a key negotiator with medical providers/vendors, you will work closely with the lead Medicare Advantage nurse coordinator to ensure reimbursement and provider write-offs are handled efficiently. Additionally, you will provide backup support for precert activities and perform all job functions within the scope of the Kansas Nurse Practice Act.

The ideal candidate will have excellent communication skills, both verbally and in writing, and be able to problem-solve using analytical reasoning and research. A registered nurse with a minimum three to five years of clinical RN nursing experience is required, with the ability to become CCM certified within two years of assuming the position.

This is an exciting opportunity to make a difference in the healthcare industry and contribute to the health and well-being of Kansans. With a competitive salary range of $72,000 - $86,000 annually, you will also enjoy a comprehensive benefits package, including incentive pay program (EPIP), health/vision/dental insurance, and tuition reimbursement.

Benefits include:
* Base pay: $72,000 - $86,000 annually
* 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

This is a great opportunity for those who are passionate about delivering high-quality patient care and are looking to grow their career in a dynamic and supportive environment.

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