This position is responsible for performing concurrent review in accordance with accepted department criteria; performing discharge planning and identifying alternate treatment programs that provide medically necessary potentially cost effective services; consulting with physicians, providers, members, and other resources, as appropriate, to assess, plan, facilitate implementation, coordinate, monitor, and evaluate options and services required to meet an individuals health needs, using communication and available resources to promote quality, cost effective outcomes; serving as liaison to physicians, and members; serving as preceptor for less experienced staff.
1) Registered Nurse (RN) with unrestricted license in state
2) 3 years clinical practice experience
3) 1 year experience in health insurance/managed care
4) PC and database experience
5) Verbal and written communication skills.
PREFERRED JOB REQUIREMENTS:
1) Experience in Disease Management
2) Experience in managing complex or catastrophic cases
3) Working toward CM certification or Advanced degree
4) Knowledge of medical management policies and procedures.
Blue Cross Blue Shield of Illinois - 19 months ago