This position is accountable for promoting interdependent collaboration with the member, physician/primary care manager, family and other members of the health care or case management team. To accomplish this collaboration, the case manager will assess, implement, monitor, and evaluate available resources in an effort to promote quality, cost effective outcomes while meeting the individual's health needs. The case manager identifies appropriate providers and facilities in an effort to improve or maintain the social, emotional, functional and physical health status of the client, as well as enhance the coping skills of the family or other caregiver.
Job Duties & Responsibilities
The case manager will perform the six essential activities of case management.
Assessment - The case manager will collect in-depth information about a person's situation and functioning to identify individual needs in order to identify members at risk for high cost medical care and develop a comprehensive case management plan that will address those needs.
Planning - The case manager will determine specific objectives, goals, and actions as identified through the assessment process. The plan should be action oriented and time specific.
Implementation - The case manager will execute specific intervention that will lead to accomplishing the goals established in the case management plan.
Coordination - The case manager will organize, integrate, and modify the resources necessary to accomplish the goals established in the case management plan.
Monitoring - The case manager will gather sufficient information from all relevant sources in order to determine the effectiveness of the case management plan.
Evaluation - At appropriate and repeated intervals, the case manager will determine the plan's effectiveness in reaching desired outcomes and goals. This process might lead to a modification or change in the case management plan in its entirety or in any of its component parts.
Registered Nurse with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law.
Minimum of five (5) years health care experience with at least three (3) years of clinical experience,
Prefer two (2) years experience in Utilization Management, Case Management or Managed Care.
Certified Case Manager (CCM) is preferred upon employment, and Case Managers are required to obtain certification within 4 years of being hired as a Case Manager.
Excellent oral and written communication skills, with problem-solving abilities.
Basic PC computer skills required with emphasis on Microsoft Office applications preferred
Various immunizations and/or associated medical tests may be required for this position.
BlueCross BlueShield of Tennessee - 13 months ago
BlueCross BlueShield of Tennessee (BCBST) is the oldest and largest not-for-profit managed care provider in the state of Tennessee....