Medical and Behavioral Case Manager RN

All about us

You likely know us as an insurance company, but that's just a portion of what we do. Hundreds of thousands of North Dakotans trust us to provide them with personalized service and unmatched access to care. It's a mission we take seriously.

We also work with entities throughout the state to challenge the cost and complexity of health care in North Dakota. This uncompromising goal requires caring, innovative people who are ready and willing to help create a new level of health and well-being in North Dakota and beyond.

Work environment

This opportunity is eligible for a remote, hybrid or in-office work arrangement. We empower our employees to find a work style that is best for them. Learn more at Life at Blue | BCBSND.

This position is eligible for internal Blue Cross Blue Shield employees and external applications.

Pay information

• Pay Level: 023
• FLSA Category: Exempt-Salaried
• Individual pay will be based on skills, experience, qualifications, location, internal equity, and other relevant factors.
• Opportunities for continued salary growth through a performance-based merit program.

A day in the life

The Medical and Behavioral Case Manager is responsible for reviewing cases of members with acute or chronic conditions and collaborates with service providers, the patient and family, and internal resources 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.

Your responsibilities will include

• 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 aiding 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.
• Collaborates with internal and external medical, utilization management and customer services teams as needed in the collaboration and coordination of the member's care throughout the case management process.

What you need to succeed

• Associate's degree/completion of an RN program
• 3 years of clinical or related experience.
• Previous case management experience is highly preferred with a good understanding of a variety of clinical concentrations.
• Comfortable with calling members and spending time on the phone.
• Intermediate computer skills with the ability to learn different systems.
• Strong ability to speak to and work well with members, designated representatives and health care providers.
• Have a desire to collaborate while also being adaptable and flexible to the needs of our members.
• Good decision making skills around care and case management.

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

Benefits

• Affordable medical, dental and vision coverage accepted throughout the United States
• Employer funded Lifestyle Spending Accounts, Health Savings Accounts and Health Reimbursement Arrangements
• Employer-paid life and disability insurance
• 401(k) retirement plan with company match and immediate vesting
• Paid holidays, paid time off (PTO), PTO donation program, and paid parental leave
• Voluntary benefits including Accident, Hospital Indemnity, Critical Illness, Term/Whole Life, Cancer Care Insurance, and more.

Additional company perks

• Robust mental health offerings including an Employee Assistance Program, Learn to Live, meQ.
• Comprehensive learning and development opportunities and an Educational Assistance Program.
• 16 hours of paid volunteer time with a $200 donation to a charity of your choice upon completion of all volunteer hours.
• Employee recognition, community initiative events and yearly company outings.
• Workplace flexibility offering different options for working arrangements and the freedom to make time for important commitments.
• Opportunities to connect through employee committees.

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 7/3/2025 at 8:00 a.m. (CT). No further applications will be considered.