Blue Cross and Blue Shield of Illinois, Montana, N RN - Care Coordinator UM/CM II (Pre-Authorization) in Albuquerque, New Mexico
We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
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BASIC FUNCTION:This position is responsible for performing concurrent, initial and retrospective reviews and case management activities in accordance with approved departmental guidelines; discharge planning and identifying alternate treatment programs for chronic or catastrophic cases while providing medically necessary cost effective services within the scope of the individual's benefit plan; applying Case Management principles in coordinating resources necessary to implement treatment options to meet the individual's health needs; and may serve as a preceptor for less experienced staff.JOB REQUIREMENTS:Registered Nurse (RN) with current, valid, unrestricted license to practice in state of operations.3 years clinical practice experience.1 year Health Insurance/Managed Care experience.Knowledge of clinical utilization management/case management activities and standardized criteria set.Knowledge of managed care and insurance industry.Familiarity of ancillary services including HHC, SNF, Hospice, Etc.Verbal and written communication skills; analytical skills; sound clinical judgment.PC proficiency to include Microsoft Word, Excel and Access.
PREFERRED JOB REQUIREMENTS:Experience managing complex or catastrophic cases.Experience in Med/Surg.Knowledge of Medical Management policies and procedures.Familiarity with medical guidelines (MCG, etc.).*Preparation of cost analysis on extra contractual benefit requests
Location: NM - Albuquerque
Activation Date: Sunday, October 16, 2016
Expiration Date: Friday, November 18, 2016