Case Management Nurse

Blue Cross and Blue Shield of Kansas is a highly trusted healthcare insurance provider with a legacy of over 80 years dedicated to commitment, compassion, and community service in the Kansas region. Known for its inclusive and family-first culture, this company is committed to advancing health and well-being by offering a range of comprehensive insurance and care management solutions. Employees at Blue Cross and Blue Shield of Kansas benefit from a dynamic work environment that fosters professional growth opportunities through continuous training and development programs, as well as a collaborative atmosphere that encourages innovation and flexibility. The total rewards package provided promotes a strong work-life balance, with benefits such as paid vacation, paid sick leave, and paid maternity and paternity leave available immediately upon hire. This organization takes pride in respecting and valuing every employee, cultivating an inclusive workplace that prioritizes trust and stability.

The Case Management Nurse at Blue Cross and Blue Shield of Kansas holds a pivotal role in managing and coordinating patient care activities to promote quality and cost-effective healthcare. This position is responsible for overseeing the day-to-day case management processes, including reviewing and processing cases, communicating with members and providers, and determining the appropriateness and cost-effectiveness of care. Additionally, the nurse negotiates reimbursement matters directly with medical providers and vendors, manages pre- and post-case management claims, and provides backup support for precertification activities. This role operates within compliance guidelines set forth by various regulatory bodies such as URAC, HIPAA, CMS, and the Kansas Nurse Practice Act, ensuring that all care management activities meet state and federal standards.

This position offers flexibility with options for hybrid or onsite work aligning with the company's Telecommuting Policy, and applicants must reside in Kansas or Missouri or be willing to relocate. The Case Management Nurse collaborates closely with a multidisciplinary team consisting of medical directors, customer service, claims, sales, provider relations, behavioral health vendors, and legal counsel. The nurse develops, implements, and monitors treatment plans that are clinically sound, cost-effective, and tailored to patient needs. This includes coordinating care across multiple providers and negotiating reimbursements where appropriate. Additional responsibilities include onboarding and training new team members, participating in multidisciplinary case management meetings, and maintaining a manageable caseload with timely documentation and follow-ups.

The salary range for this position varies based on certification status, with non-certified nurses earning between $73,920 and $92,400 annually and certified nurses earning between $85,600 and $107,000. Blue Cross and Blue Shield of Kansas values fairness and equity in compensation, ensuring that offers reflect the candidate's skills, education, experience, and training. Overall, this role promises an opportunity to work in a supportive, impactful environment where your contributions directly affect the health outcomes of Kansans and their communities.