Medical Case Manager (Johnson City and/or Memphis, TN)
BlueCross BlueShield of Tennessee - Johnson City, TN

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General Summary

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.
Position Specific – SGMM CM

Job Duties & Responsibilities

Responsible for carrying out key functions related to the success of the case management program to include acting as key liaison between the practice and the health plan

Performs functions, as necessary, for members identified as having high risk pregnancies, high risk infants that meet eligibility requirements for the program

Assesses, identifies, educates, collaborates, prioritizes needs, and builds rapport and trust through education regarding pregnancy and prenatal care

Qualifications

Education

  • 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.
Experience

  • 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.
Skills/Certifications

  • 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.
Position Specific – SGMM CM

Job Qualifications

Three (3) years of obstetric and/or high risk OB clinical nursing experience, neonatal, prenatal educator experience is a plus

Skills/Certifications

Proficiency with Motivational Interviewing and/or other behavioral change techniques

Ability to build rapport and engage members in effective dialogue related to their treatment plan

Ability to quickly identify and prioritize member needs and provide structured and focused support and interventions

Exceptional level of critical thinking, analytical and creative problem solving skills required.

Exceptional level of independence, organization, and interpersonal skills required.

Proficient with team-building processes and participation in cross-functional teams

Job Competencies (no more than 10)

Excellent oral and written communication skills, with problem-solving abilities

Exceptional interpersonal communication skills are required

Excellent assessment skills

Basic computer skills including data entry

Navigational knowledge of data systems as appropriate

BlueCross BlueShield of Tennessee - 21 months ago - save job
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BlueCross BlueShield of Tennessee (BCBST) is the oldest and largest not-for-profit managed care provider in the state of Tennessee....