Nurse Case Manager
Location: Omaha Nebraska
Description: Blue Cross Blue Shield of Nebraska is looking of Nurse Case Manager right now, this career will be placed in Nebraska. For detail informations about this career opportunity please give attention to these descriptions. The Nurse Case Manager works collaboratively with health care providers to ensure that members receive high quality, medically necessary care in a timely fashion in a setting that maximiz! es benefit coverage and health outcomes. The Nurse Case Manager educates members to understand innovative benefit structures that promote transparency and affordability and empowers consumers to make informed decisions regarding their healthcare options, coverage, and financial risk. The Nurse Case Manager assists members to navigate the complex health care settings and ensures that they get the support they need throughout the episode of care to optimize health status. Essential Duties and Responsibilities: Follow the nursing process of assessment, planning, implementation, and evaluation of member-centric goals and interventions for members enrolled in the case management program.
Certification and authorization reviews to assess the medical necessity of inpatient admissions, outpatient services, out-of-network services, and appropriateness of treatment setting by utilizing and accurately interpreting applicable medical policy, clinical criteria, standards of car! e, contract language, benefits, and member eligibility. Facili! tate appropriate and timely transitions of care utilizing member’s contract language and clinical criteria. Identify members at risk for post-discharge complications or potentially preventable readmissions and follow-up with members after return home to ensure member is able to obtain medically necessary care, understands discharge instructions and plan of care, understands warning signs of complications and knows what actions to take to address changing health status. Responsible to collaborate and consult with healthcare providers, members, and internal team of nurses, physicians, medical directors and pharmacists to ensure medically appropriate, high quality, cost-effective care, promote positive member outcomes, effective use of resources, optimize member benefits, and support business initiatives.
Screen and triage members for levels and types of nurse advocacy and medical management programs, including but not limited to: discharge follow-up for potentially! preventable readmissions, onsite visit program, care coordination, light touch care management, member outreach, palliative and hospice care management, and complex case management. Act as a resource within the department and to other departments regarding medical management issues and activities. Educate members about their benefits and coverage, and guide members to appropriate programs, community resources, and in-network providers. Facilitates accreditation by knowing, understanding, and adhering to accrediting and regulatory requirements and standards Must meet or exceed the attendance and timeliness requirements of their departments.
Must work well in a team environment, and be capable of building and maintaining positive relationships with other staff, departments, and customers.
- .
If you were eligible to this career, please email us your resume, with salary requirements and a resume to Blue Cross Blue Shield of Nebraska.
If you interested on this career just click on the Apply button, you will be redirected to the official website
This career starts available on: Thu, 28 Mar 2013 13:39:00 GMT