Blue Cross and Blue Shield of Illinois, Montana, N Holistic Health Specialist in Abilene, Texas



BASIC FUNCTION:This position is responsible for performing a variety of functions and is a single source of contact for members, health care personnel and all other entities involved in managing care. 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 determining member assignment of treatment, and pre-admission/post-discharge counseling for an acute condition. Establish relationship with the member. Handle immediate post discharge follow-up 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, 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. Provide oversight to Holistic Health Coordinators. JOB REQUIREMENTS:Registered Nurse (RN) with current, valid, unrestricted license in state of operations2 years of clinical practice experience of direct clinical care to the customer 1 year of experience in care management/condition management in a health insurance/managed care settingPC proficiency to include Word, Excel, Lotus Notes and database experienceClear and concise verbal and written communication skillsFamiliarity of ancillary services including HHC, SNF, Hospice, etcAnalytical skillsDecision making skills and sound clinical judgment to provide oversight of other staff*Incumbents with nursing licenses in positions/departments requiring multi-state licenses are required to obtain and maintain additional current, valid, and unrestricted applicable nursing licenses in other states as determined by management. Multi-state license fees will be provided by HCSC. Incumbents with other clinical licenses are not required to obtain multi-state licenses.

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/MCG certification or Advanced degreeKnowledge of Milliman Guidelines or similar clinical guidelines*Knowledge of medical management policies and procedures.

Location: TX - Abilene, TX - Richardson

Activation Date: Tuesday, July 10, 2018

Expiration Date: Saturday, August 11, 2018

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