Case Management Nurse I

Wellmark Blue Cross and Blue Shield

Case Management Nurse coordinating personalized care plans for Wellmark, a member-owned health insurance company. Supporting complex needs through care navigation, education, referrals, and provider collaboration.

Posted 8/18/2026contractRemote • Iowa • 🇺🇸 United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in care coordination and management, with a strong focus on chronic health care needs and member engagement. Proficient in utilizing clinical documentation platforms and adhering to regulatory standards such as HIPAA and URAC.

Highest-signal resume keywords

Active RN LicenseCertified Case Manager (CCM)4+ Years Clinical ExperienceCare Coordination ExperienceStrong Verbal Communication

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Care NavigationClinical DocumentationUtilization ManagementBehavioral Health ExperienceCritical ThinkingProblem-SolvingMicrosoft OfficeRegulatory ComplianceMember EducationIndividualized Care Plans

Soft Skills

Strong Written CommunicationOrganizational SkillsDecision-MakingFlexibilityInterpersonal Skills

Tools & Technologies

Clinical Documentation PlatformsTechnology Tools

Certifications & Qualifications

RN License in Iowa or South DakotaCertified Case Manager (CCM)

Industry Keywords

Chronic Care ManagementHealth Care CoordinationURAC StandardsNCQA StandardsHIPAA CompliancePHI Confidentiality

About the role

Key responsibilities & impact

Engage members through multiple channels to support chronic and/or complex health care needs
Create and manage individualized care plans
Partner with members, families, health care providers, and community resources to coordinate care and services
Recognize high-risk and complex conditions and anticipate member needs
Discuss care needs using supportive interventions and planning techniques
Identify barriers and gaps to care and prevent duplication of services
Educate members about benefits, services, accountabilities, and expected outcomes
Research resources and programs as science and technology evolve
Collaborate with internal and external clinical and nonclinical stakeholders
Facilitate referrals to providers, community resources, and Wellmark programs
Document care management activities accurately, consistently, and timely using relevant technology tools
Comply with regulatory, accreditation, and internal standards
Work weekend and/or holiday hours on a rotational basis when needed
Perform other duties as assigned

Requirements

What you’ll need

Completion of an accredited nursing program
Active and unrestricted RN License in Iowa or South Dakota
Must be licensed in the state in which the individual resides
Certified Case Manager (CCM); must obtain within 24 months of hire and maintain throughout the position
4+ years of diverse clinical experience, including 4+ years of direct clinical care to consumers
Care navigation/care coordination experience strongly preferred
Behavioral health experience preferred
Prior health plan experience preferred
Experience in utilization management or a health insurance setting beneficial
Strong verbal communication and written documentation skills
Critical thinking and problem-solving skills
Ability to make independent decisions or recommendations under ambiguity
Ability to organize and manage multiple priorities in a dynamic environment
Strong technical acumen, including Microsoft Office and clinical documentation platforms
Knowledge of URAC, NCQA, HIPAA, and PHI confidentiality standards
Flexibility to work rotational weekend and/or holiday hours when needed
Must provide high-speed internet at the work location
Must not require immigration sponsorship or additional/permanent work authorization sponsorship now or in the future to work in the United States

Benefits

Comp & perks

Fully remote work eligibility
Option to work from a Wellmark office depending on location
High-speed internet provided by the candidate at their work location
Opportunity to use responsible AI tools in the workforce and application process