Case Manager - Sr (Acute) at Meridian

Job Description

Under limited supervision, support the medical/utilization case management initiatives to ensure the delivery of medically necessary, appropriate, cost-effective and quality care. To perform utilization, case and telephonic/onsite care management for healthcare delivered in all settings.

Required Experience:
* Registered Nurse Candidates - Five (5) years clinical nursing
* Social Worker Candidates - Five (5) years medical based social work with an emphasis on complex, geriatrics and chronically/terminally ill patients (to include case management, discharge planning and utilization review)

Required Education:
* Bachelors degree in Science ( BSN) or Bachelors degree in Social Work ( BSW)Social Work

Required Certifications/Licenses:
* Registered Nurse Candidates - Valid unrestricted Idaho Registered Nurse License (RN)
* Social Worker Candidates - Valid unrestricted Idaho Social Worker License (LSW)

Required Knowledge, Skills and Abilities (KSAs):

Knowledge of:
* Managed care delivery systems
* Utilization management
* Care Coordination/Case Management
* Quality Improvement (QI)
* National Commission on Quality Assurance (NCQA) accreditation standards
* Utilization Review Accreditation Committee (URAC) accreditation standards
* Center for Medicare and Medicaid Services (CMS)
* Quality improvement

Skills:
* Interpersonal
* Verbal and written communication
* Analytical
* Problem solving
* Organizational
* Independent & critical thinking
* Self-motivation
* Negotiation
* Project management
* Microsoft Word - Basic
* Microsoft Excel - Basic
* Microsoft Outlook - Basic
* Personal computer

Ability to:
* Manage assigned caseload in a quality and cost-effective manner
* Respond to families in crisis and assess coping skills
* Maximize discharges to the highest level of independence
* Establish and maintain relationships with contracting facilities and physicians
* Communicate with diverse audiences
* Give and receive constructive feedback in a team environment
* Schedule time effectively
* Work with minimal supervision
* Handle multiple projects simultaneously
* Prioritize work appropriately

PREFERRED QUALIFICATIONS:
* Previous experience in a hospital or health plan setting in case management/utilization review
* Certified Case Manager (CCM) or certification as a case manager from the URAC approved list of certifications.
* Social Worker Candidates - Masters degree in Social Work

Position Reports To: Manager, Case Management
Starting Salary (Grade 16): $54,798 - $68,498
Internal Posting Close Date: 11/20/2013
External Posting Close Date: Until Filled

Come work for a leading Health Insurance carrier in Idaho. To learn more about the requirements for this position, to search other employment opportunities and to apply online please visit our Web site at www.bcidaho.com/careers. We offer excellent benefits and competitive salaries, including incentive programs, 401(k), paid holidays, and much more! EEO/AA/D/V

Job Requirements

 
Country: USA, State: Idaho, City: Meridian, Company: Blue Cross of Idaho.