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Care Management Nurse

Company: Regence BlueShield
Location: Burlington
Posted on: November 22, 2021

Job Description:

Care Management NurseRemote in WA, OR, UT, ID. Candidates outside of these states will not be considered Following federal mandate, all Cambia employees, including telecommuters, need to be fully vaccinated for COVID-19 by 1/1/22. Are you a Registered Nurse that has a passion for making a difference? Our Care Managers are uniquely positioned to be an essential link and a real advocate for members to make strong connections between helping individuals navigate the healthcare system, as well as assisting them in understanding whatever circumstance or condition brought them to need those services in the first place. The Care Manager uses their clinical judgement and expertise through a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality, cost effective outcomes.Responsibilities

  • Interacts with members/clients and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers telephonically.
  • Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate.
  • Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, the use of community resources, and alternative levels of care.
  • Uses clinical judgement and expertise to find resources and remove barriers to members/client's care.
  • Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client's appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate.
  • Works with members/client's physician or specialists to support and collaborate on the members treatment plan.
  • Provides educational and prevention information to member's/client's increasing their health knowledge for best medical outcomes. Minimum Requirements
    • Effective computer skills with ability to navigate multiple systems and proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications.
    • Strong communication, organizational, and interpersonal skills -
    • Ability to interpret policies and procedures, make decisions, and communicate complex topics effectively. -
    • Strong organization and time management skills with the ability to manage workload independently. -
    • Ability to think critically and make decision within individual role and responsibility.Normally to be proficient in the competencies listed above:
      • Care Management Clinician would have a/an Associate or Bachelor's Degree in Nursing or related field and 3 years of case management, utilization management, disease management, or behavioral health case management experience or equivalent combination of education and experience.Required Licenses, Certifications, Etc.
        • Must have 3 years direct clinical experience as a current and unrestricted Registered Nurse (RN) in WA and willing to be licensed in multiple states.

Keywords: Regence BlueShield, Bellingham , Care Management Nurse, Healthcare , Burlington, Washington

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