Blue Cross and Blue Shield of Illinois, Montana, N Primary Nurse Case Admin I in Chicago, Illinois
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 individuals 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 of clinical practice experience with direct clinical care to the customer 1 year experience in Condition Management or Case Management in a health insurance, managed care, physician office or hospital setting. *PC 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, etcVerbal and written communication skills; analytical skills; sound clinical judgmentIncumbents 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 certification or Advanced degreeKnowledge of Milliman Guidelines or similar clinical guidelines*Knowledge of medical management policies and procedures
Location: IL - Chicago
Activation Date: Friday, July 13, 2018
Expiration Date: Saturday, July 28, 2018