[Hiring] Clinical Nurse, Case and Disease Management @Blue Cross and Blue Shield of Kansas City

Role Description

Utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote optimal, cost-effective outcomes. Transplant only: Provides prior authorization for, coordinates, and individually manages all member transplants. Acts as an internal and external customer resource for interpretation of transplant benefits and transplant-related claim adjudication. Serves as a company expert on current and future transplant types. The candidate for this position must reside in the Kansas City metropolitan area.

• Completes member assessments by collecting and analyzing information across the seven domains of health.
• Develops and implements individualized care plans with appropriate interventions in a culturally sensitive way.
• Monitors effectiveness of plan of care by gathering sufficient information from relevant sources.
• Acts as liaison between member, employer, providers, support system and BlueCross BlueShield of Kansas City.
• Prioritizes interventions based on clinical need and readiness to change.
• Educates and works with members at different educational and health literacy levels.
• Meets individual quality performance standards and annual targets for program performance.
• Schedules time effectively and works with minimal supervision.

Qualifications

• Associate degree in nursing.
• 3 years full-time direct patient care clinical experience in either transplant, oncology or medical/surgical.
• Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
• Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Thorough knowledge of URAC and NCQA® guidelines and state and federal regulations.
• Valid and active Registered nurse (RN) in Missouri and Kansas.
• Case Management Certification within 3 years of hire date or within 3 years of transfer to Case Management role/department.

Requirements

• Provides prior authorization of the transplant and manages individual member cases.
• Educates members, providers, and other customers regarding transplant benefits.
• Ensures proper payment of pre-transplant, transplant, and post-transplant claims.
• Accurately reports potential high cost members and tracks costs on members currently undergoing transplants.
• Serves as transplant information source for other departments of the company.

Benefits

• Highly competitive total rewards package, including comprehensive medical, dental and vision benefits.
• 401(k) plan that both the employee and employer contribute.
• Annual incentive bonus plan based on company achievement of goals.
• Time away from work including paid holidays, paid time off and volunteer time off.
• Professional development courses, mentorship opportunities, and tuition reimbursement program.
• Paid parental leave and adoption leave with adoption financial assistance.
• Employee discount program.