Blue Cross And Blue Shield Insurance Work Values

Daily Duties at Blue Cross And Blue Shield Insurance:

Case Manager RN-Job duties include but are not limited to the following:•Engage health plan members primarily through telephonic outreach activities • Serve as an advocate for members admitted to facilities and assist them in transitioning through the continuum, educate regarding benefits, condition/illness, self-management strategies and discharge planning/coordination and initiate Care Program referrals as appropriate .• Plan, coordinate and implement discharge ...Ensured compliance with all state and federal regulations as well as Corporate guidelines in day-to-day activities. Maintained accurate records of case management activities in the JIVA system using clinical guidelines. Work with physician and member closely regarding chronic disease process and refer to qualified programs. Educate member on medication adherence and understanding of the medications they are taking and why. Educate on any side effects and to call MD immediately if one should occur. The Nurse Care Manager works directly with HHC agencies to develop and implement a single, integrated Care Plan, and ensures collaboration and coordination among all providers of services to the member and the member's family/supports. Comprehensive Care Management, Care Coordination, Health Promotion, Comprehensive Transitional Care, Member and Family Support, and Referral to Community Supports and Services. My primary responsibilities were to provide comprehensive care management to identified members to promote continuity and consistency of care, minimize duplication, and increase the opportunities for members to improve their health. Develop a comprehensive health-based needs assessment and a care plan for each member with input from the member, other providers, the member's family or others who provide support Monitor member's health care appointments and pertinent medical information, and share necessary information and outcomes in collaborative communication with other providers and external providers.Talk with members regularly, or more frequently when needed, to review member's understanding of health care needs, and adherence to the member's care plan. Coordinate with other providers to identify and address barriers to member's success, including member understanding of health conditions and prescribed treatment.. Follow up with physicians and external providers to find ways to address barriers. Routinely re-assess member's needs, and revise care plan to reflect changing needs.• Cross cover for other nursing staff when necessary or otherwise indicated by management staff.Complete, individually when able and collaboratively when indicated, any paperwork required or in support of health care delivery to the patient (prior authorizations.• Provide transitional care coordination for member's and their families/support persons when member's are transitioning home from an inpatient or other stay, or changing from one provider to another.Provide support to families and support persons in their efforts to care for and support member.Provide referral to community resources, individually or in coordination with other Florida Blue providers. Develop and implement relationship-building activities with other medical providers serving our shared members.Work collaboratively with other providers to ensure smooth delivery of services. • Regular and reliable attendance is required. PERFORMANCE STANDARDS: •As outlined in current scorecard attached to this position description Requirements: Nurse Care Manager EDUCATION AND LICENSURE: Required: • Registered nurse with active Kansas license. EXPERIENCE: Required: • Experience in working with diverse populations in delivery of medical care

What they like about Blue Cross And Blue Shield Insurance:

The social vibrance of a hiring firm is very important to you. Your ability to make and maintain friendships there is a critical part of your decision. You would likely be dissatisfied with a workplace that is quiet, cold, or otherwise not particularly social. When you investigate a new hiring company, ask recruiters, managers, and potential co-workers about the social life and opportunities there. This is especially important when you are relocating; moving dramatically alters your social sphere both inside and outside the workplace.

Tags

Ft Myers Fl, Cape Coral Fl, interqual and keypro for medicaid care management

Skills

operating nurse, case manager, supervisor, RN Care Manager

These are some of the questions we asked our climbers about their experiences with Blue Cross And Blue Shield Insurance: