Blue Cross and Blue Shield of Illinois, Montana, N Primary Nurse Case Administrator I in Richardson, Texas


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BASIC FUNCTION:This position is responsible for performing all functions of Utilization Management (UM), Case Management (CM) and Disease Management (DM) and is a single source of contact for members, health care personnel and all other entities involved in managing care. The Primary Nurse Coordinator performs concurrent review, discharge planning and care coordination; identifies alternate treatment programs; consults with physicians, providers, members, and other resources to evaluate options and services required to meet an individual's health needs; promotes quality and cost effective outcomes; and serves as liaison to physicians and members. Other functions also include episodic case management, determining member assignment of treatment, and pre-admission/post-discharge counseling for an acute condition. Establish relationship with the member through the immediate post discharge follow-up period or until all short term care needs are met. Provide education/local resource information and encourage member (self) education. Functioning in a clinical care advisory role, the Primary Nurse Coordinator assesses members for wellness education and disease management, introduces members to our website tools, educates members regarding wellness and specific conditions, and facilitates the coordination of care for identified members. JOB REQUIREMENTS:Registered Nurse (RN) with current, valid, unrestricted license in state of operations2 years clinical practice experience of direct clinical care to the customer 1 year experience in Condition Management or Case Management in a health insurance/managed care settingPC proficiency to include Word, Excel, Lotus Notes and database experienceClear and concise verbal and written communication skillsKnowledge of UM/CM/DM activities and standardized criteria setFamiliarity of ancillary services including HHC, SNF, Hospice, etc.Verbal and written communication skills; analytical skills; sound clinical judgment

PREFERRED JOB REQUIREMENTS:Experience in managing complex or catastrophic health casesSpecialty clinical experience in intensive care medicine, orthopedic, NICU/pediatric, oncology, diabetic member management, obstetric (low to high risk maternity management)Working toward or completion of CCM/CCP/CDE certification or Advanced degreeKnowledge of Milliman Guidelines or similar clinical guidelinesKnowledge of medical management policies and proceduresCOMPETENCES:Development DiversityFocus on the CustomerFocus on ResultsStrategic Perspective*Teamwork

Location: TX - Richardson

Activation Date: Monday, October 10, 2016

Expiration Date: Wednesday, November 30, 2016

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