Care Coordinator - Enhanced Case Management

Blue Cross and Blue Shield of Alabama; Birmingham (AL); Vor Ort; USD 65.000 - 85.000; Vollzeit

Zusammenfassung

Blue Cross and Blue Shield of Alabama seeks a Registered Nurse to oversee the Member Management Programs within the Health Management division. You will assess member needs and coordinate case management to ensure quality care across the healthcare delivery system.

The role requires clinical experience in medical/surgical, psychiatric, or obstetrical settings, active Alabama RN licensure (or Multi-State Compact), and strong communication with providers and subscribers.

Qualifikationen

• Bachelor’s Degree or commit to actively pursue a degree
• Active RN license in good standing
• Alabama RN license or Multi-State Compact license
• Minimum of three years of clinical experience in medical/surgical settings, psychiatric, or obstetrical
• Effective verbal and written communication with providers, subscribers and group representatives
• Experience in autonomous decision-making and independent analysis
• Willingness to travel up to 10% of the time

Aufgaben

• Develop, coordinate, and administer all activities related to Member Management Programs
• Communicate with members, providers, subscribers and group representatives
• Coordinate case activity and maximize member’s contract benefits by evaluating needs and developing alternative plans of treatment for quality care

Kenntnisse

RN License

Clinical experience

Communication

Independent decision-making

Travel up to 10%

Ausbildung

Bachelor’s Degree

Alabama RN License or Compact

Jobbeschreibung

Department Overview

The Health and Clinical Engagement division provides valuable health and wellness services to help people maximize their health and quality of life. Health Management is one of the most critical issues Blue Cross and Blue Shield of Alabama faces in fulfilling its responsibility to be a superior administrator of health care benefits. Our goal is to provide the highest quality benefits and services while we effectively control health care costs.

Primary Responsibilities

This position is accountable for developing, coordinating, and administering all activities related to Member Management Programs. Activities involve effective communication with all members of the health care delivery system and group representatives. Individual member assessment and coordination of case management activities are additional responsibilities. The incumbent coordinates case activity and maximizes the member’s contract benefits by evaluating the member’s needs and developing alternative plans of treatment to provide quality care.

Summary Of Qualifications

• Bachelor’s Degree or upon hire commit to actively pursue a degree
• Active License in good standing as a Registered Nurse (RN)
• State of Alabama licensure as a Registered Nurse OR Multi-State licensure as a Registered Nurse (Compact)
• Minimum of three years of clinical experience in medical/surgical health care fields, a psychiatric, and/or an obstetrical setting
• Effective verbal and written communication skills with providers, subscribers and group representatives
• Experience analyzing and making informed decisions in an autonomous setting
• Experience in a position interpreting and communicating information orally and written with all levels of staff internal and external
• Experience in a position requiring independent decision-making skills
• Willingness to work a flexible schedule in order to provide telephone coverage
• Willingness to travel up to 10% of the time as needed
• Experience in a position using negotiation skills preferred
• Experience in a position presenting information in formal and informal settings preferred
• Certified Case Manager preferred
• Experience caring for patients with complex conditions such as COPD, diabetes, oncology, etc. preferred
• Experience with complex case management preferred