Case Management Triage Nurse

Blue Cross and Blue Shield of Kansas is seeking a qualified RN to support our Case Manager and Supervisor in the resource utilization and triage of members.

• Incentive pay program (EPIP)
• Health, Vision, and Dental insurance
• 6 weeks paid parental leave for new mothers and fathers
• Fertility and Adoption assistance
• 2 weeks paid caregiver leave
• 401(k) plan matching up to 5%
• Tuition reimbursement
• Health & Fitness benefits, discounts and resources

With the support of the Supervisor Case Manager and Triage Nurse, the RN will carry primary and independent responsibility for the day‑to‑day activities of researching, reviewing, processing, initial screening, and triage of members identified in resource utilization programs as well as from any other source. Responsibilities include appropriate identification and referral of members for potential case management (CM) intervention, testing discharge call outreach (DCO) system development, and conducting all activities in compliance with State, URAC, HIPAA, DOL, CMS, and MTM goals and/or guidelines.

• Collaborate with case managers and supervisor/management to identify, clinically research, and triage potential members for CM.
• Coordinate CM identification activities with case managers and other area staff for optimal process efficiency.
• Collaborate with other areas (e.g., health analytics, disease management) to promote management of BCBSKS members and achieve corporate goals such as HEDIS/Stars.
• Perform initial clinical review on referred cases, including FEP plan to plan referrals not sent directly to a case manager, and review claims system or care coordination portal alerts as needed.
• Triage referred cases to other programs or resources (e.g., pharmacy, disease management, rare disease management, wellness programs).
• Conduct independent review of medical information without direct supervision, determining which cases require CM input or medical consultant expertise under limited time constraints.
• Answer and triage general CM telephone lines for all lines of business, directing calls to the appropriate case manager or other area as needed.
• Maintain activity level and documentation to meet URAC, CMS, group and/or corporate requirements.
• Perform all job functions within the scope of the Kansas Nurse Practice Act.
• Conduct resource utilization program activities (e.g., post‑discharge member contact, avoidance of unnecessary emergency department use).
• Deliver onsite training and orientation for new department employees.

• Associate Degree in Nursing (ADN) required;
  Bachelor of Science in Nursing (BSN) preferred.
• Registered nurse with a minimum of three years of RN clinical nursing experience required; acute medical/surgical experience preferred.
• Current, active, and unrestricted Kansas RN license.
• Experience with government programs preferred.
• Excellent communication skills—verbal, written, and telephone—regarding confidential and sensitive issues while maintaining a professional image.
• Strong analytical reasoning, research, and problem‑solving abilities.
• Self‑directed, self‑motivated, and capable of making independent decisions while prioritizing daily activities.
• Awareness and understanding of current medical care practices.
• Ability to work alternative hours, including evenings and weekends, if required.

95% of daily activity requires use of a computer and/or telephone.

$73,920 - $92,400 annually (Exempt Grade 15). The compensation range is a good faith estimate based on the successful candidate’s qualifications and experience.

Blue Cross and Blue Shield of Kansas provides equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information, military or veteran status, family or parental status, or any other characteristic protected by applicable law.

The election to benefit from these opportunities is based solely on merit, qualifications, and merit.