Blue Cross and Blue Shield of Illinois, Montana, N RN - Care Coordinator UM/CM II (Pre-Authorization) in Albuquerque, New Mexico


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BASIC FUNCTION:This position is responsible for performing concurrent, initial and retrospective reviews and case management activities in accordance with approved departmental guidelines; discharge planning and identifying alternate treatment programs for chronic or catastrophic cases while providing medically necessary cost effective services within the scope of the individual's benefit plan; applying Case Management principles in coordinating resources necessary to implement treatment options to meet the individual's health needs; and may serve as a preceptor for less experienced staff.JOB REQUIREMENTS:Registered Nurse (RN) with current, valid, unrestricted license to practice in state of operations.3 years clinical practice experience.1 year Health Insurance/Managed Care experience.Knowledge of clinical utilization management/case management activities and standardized criteria set.Knowledge of managed care and insurance industry.Familiarity of ancillary services including HHC, SNF, Hospice, Etc.Verbal and written communication skills; analytical skills; sound clinical judgment.PC proficiency to include Microsoft Word, Excel and Access.

PREFERRED JOB REQUIREMENTS:Experience managing complex or catastrophic cases.Experience in Med/Surg.Knowledge of Medical Management policies and procedures.Familiarity with medical guidelines (MCG, etc.).*Preparation of cost analysis on extra contractual benefit requests

Location: NM - Albuquerque

Activation Date: Sunday, October 16, 2016

Expiration Date: Friday, November 18, 2016

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