Description
Temporary Employees: Are not eligible to apply for internal positions posted on the Intranet. Temporary employees are eligible to apply for any opportunities posted externally on the Internet at www.bcbsla.com once they have completed the minimum hours requirement in the temporary position.
Internal Applicants: Must meet the following two criteria in order to apply:
1. In their current job for 12 months
Where there is a formal classroom training program such as with customer service and claims processing jobs, the 12 month period will begin when the employee completes the training program and enters the job on a full time basis
2. In good standing(no disciplinary action and no rating of Needs Improvement on most recent review)
Applicants from within the department requesting the position are not required to meet the twelve-month criteria if the posted position is part of a natural career progression.
QUALIFICATIONS:
RN licensed to practice in Louisiana required. Bachelor's Degree in Nursing or health related field is preferred.
Chronic Disease Management Certification preferred or must be attained within 36 months. Related nursing specialty certification can be used in lieu of CDMC.
Three years of direct patient care/clinical experience required, or two years direct patient care/clinical experience plus case or chronic disease management certification.
Experience in research and analysis of contracts/cases and in making appropriate quality and cost effective decisions.
Ability to work independently and make decisions and with general supervision plan, implement and evaluate appropriate healthcare services in conjunction with a physician treatment plan evaluating the effectiveness of alternate care services.
Experienced in use of behavioral interviewing techniques and theory required.
Demonstration of strong communication skills, including the ability to effectively explain/present claims information and procedures to persons with varied levels of health literacy and insurance/benefits understanding.
Ability to quickly establish rapport over the telephone and complete telephonic assessments as indicated through work experience.
Able to travel within the state, if needed.
ACCOUNTABILITIES:
Responsible for assessment of members health status by collecting and analyzing in-depth information across seven dimensions of health (clinical, functional, financial, support system, psychosocial, cognitive, and environmental) and to develop, and implement individualized care plans with appropriate disease management interventions and services in a culturally sensitive way. Evaluates benefits and alternative care services in conjunction with the physician treatment plan to facilitate cost effective, quality care and self care. Assists with benefits management as needed.
Monitors effectiveness of plan by gathering sufficient information from relevant sources in order to intervene, as appropriate to improve health outcomes. Responsible for stratification of members to appropriate program level of intervention and evaluation of stratification level using defined criteria no less than every six months for members in case load.
Responsible for identification of major health risk factors, reinforcement of physicians plan of treatment, and assisting members to set goals and achieve self care objectives. Acts as liaison between member, employer, providers, support system and health plan.
Responsible for prioritizing interventions based on clinical need and readiness to change. Educates and works with members at different educational and health literacy levels.
Responsible for meeting individual quality performance standards and annual targets for program performance as mutually agreed to by management team to maximize program value. May provide guidance to less experienced nurses.
Responsible for meeting targets for program performance, such as monthly productivity and annual caseload requirements as mutually agreed to by management team to maximize program value.
Prepares case reviews and summaries of member management activities for management and client review.
This position reports to the Manager, Health Services.
This position is a grade 13. The starting minimum salary is $4,159.42/mo.
Details:
Job Id:
18873405
Annual Salary:
Position Type:
Education Level:
No Selection
Experience Level:
No selection
Posted:
2/6/2010 2:38:14 AM
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