Case Management Nurse I

Wellmark Blue Cross and Blue Shield

Case Management Nurse coordinating individualized care plans for Wellmark, a mutual Iowa–South Dakota health insurer. Supporting members with complex needs through clinical guidance, referrals, and care coordination.

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

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in care coordination and management, utilizing critical thinking to address complex health care needs while ensuring compliance with regulatory standards. Proficient in documentation and communication, with a strong focus on member engagement and education.

Highest-signal resume keywords

Active RN LicenseCertified Case Manager (CCM)4+ Years Clinical ExperienceCare Coordination ExperienceKnowledge of HIPAA Regulations

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Care NavigationUtilization ManagementAccurate DocumentationCritical ThinkingProblem-SolvingKnowledge of ResourcesIndependent Decision-MakingMicrosoft Office ProficiencyAttention to DetailOrganizational Skills

Soft Skills

Strong Verbal CommunicationStrong Written CommunicationFlexibilityAdaptability

Tools & Technologies

Case Management PlatformsMicrosoft OutlookMicrosoft ExcelMicrosoft Teams

Certifications & Qualifications

Certified Case Manager (CCM)

Industry Keywords

Chronic Care ManagementBehavioral HealthHealth Plan ExperienceURAC StandardsNCQA StandardsPHI 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
Use critical thinking to identify high-risk and complex conditions and anticipate member needs
Discuss care needs using supportive interventions and effective planning techniques
Identify barriers and gaps to care and ensure appropriate care, communication, education, and avoidance of duplicated services
Engage members in care management plans and educate them on accountabilities, outcomes, benefits, and services
Research evolving resources and programs and collaborate with Wellmark stakeholders
Facilitate referrals to providers, community resources, programs, 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 they reside
Certified Case Manager (CCM), to be obtained within 24 months of hire and maintained 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 and written communication skills
Accurate documentation in case management platforms
Critical thinking and problem-solving skills
Knowledge of resources, processes, and guidelines
Ability to make independent decisions or recommendations under ambiguity
Ability to organize and manage multiple priorities
Timeliness, follow-up, accuracy, and attention to detail
Flexibility and adaptability to change
Strong technical acumen and ability to learn new systems quickly
Microsoft Office proficiency, including Outlook, Excel, and Teams
Knowledge of URAC, NCQA, HIPAA, and PHI confidentiality standards and regulations
Flexibility to work weekend and/or holiday hours rotationally when needed
Ability to provide high-speed internet at the work location
Must not require immigration sponsorship or additional/permanent work authorization 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
Responsible use of AI supported and encouraged
Equal opportunity employment
Reasonable accommodations during the employment application process