Clinical Account Manager RN

<p>With more than 7,000 employees, we are the largest health insurance company in Michigan. We offer an exciting work environment with a diverse group of employees. Our goal is to make health insurance easier for our members. We want to transform the industry and become a resource that people can trust.</p>

Detroit, MI

Blue Cross Blue Shield of Michigan

When you think of <a href="" target="_blank" rel="noopener noreferrer">Blue Cross Blue Shield of Michigan</a> for health insurance, you can know you&rsquo;re getting much more. We're a company founded on a tradition of affordable, quality health care for everyone, improving the present and investing in the future.<br /><br />We offer:<br />Plans for employers and individuals that meet today&rsquo;s needs, budgets and lifestyle<br />The largest network of doctors and hospitals in the state<br />Lower health care costs Higher quality health care<br />Award-winning diversity practices<br />Grants and programs that promote better health throughout Michigan<br /><strong><br />Mission:&nbsp;</strong>We commit to being our members&rsquo; trusted partner by providing affordable, innovative products that improve their care and health.<br /><br /><a href="" target="_blank" rel="noopener noreferrer"><strong>Click here</strong></a> to learn more about our commitment to our Social Mission, view company updates and reviews, and view our awards &amp; accolades.<br /><br />Learn more about your options as an external candidate. <a href="" target="_blank" rel="noopener noreferrer">Click here</a> to view open positions.

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Competitive Total Compensation Package

Overview: Serves as the primary clinical resource to inform, develop, and oversee clinical strategy for the largest self-insured group commercial accounts. Acts as a clinical subject matter expert to address clinical questions on behalf of the account. Serves as the customer-facing Subject Matter Expert and monitors and addresses the performance of the various clinical programs offered by BCBSM and vendor partners. Investigates specific clinical concerns on behalf of the group customer or the BCBSM account team.
Responsibilities: <ul> <li>Collaborates with Customer Consulting and Account Management teams to develop, implement, and track account specific clinical strategies meant to reduce cost and improve member health.</li> <li>Investigates and develops solutions to address customer specific clinical issues/questions. Identifies the specific clinical cost and use drivers of customer spend and recommends solutions.</li> <li>Reviewing existing and new clinical programs offered by the organization to ensure proficiency.</li> <li>Coordinates and attends account meetings, seminars, trade fairs and employee events.</li> <li>Reviews medical information and records to evaluate patient needs and treatment and responds to group inquiries regarding large medical claims. Assures the proper medical management protocol has been employed. Coordinates the information flow between BCBSM case management staff and group when needed.</li> </ul>
Requirements: <ul> <li>Nursing diploma or associates degree in nursing required.</li> <li>Bachelors degree in nursing or related field preferred.</li> <li>Two (2) to four (4) years of related clinical experience required.</li> <li>Two to four years of health plan experience in Care Management, Utilization Management and/or other related discipline required.</li> <li>Progressive experience managing teams of nurses in either the clinical setting or as part of a Care Management/Utilization Management team.</li> <li>Deep understanding of drivers of healthcare spend and opportunities to address. MBA preferred.</li> <li>Registered Nurse with current Michigan Registered Nurse license required</li> <li>Certification in Case Management (CCM) preferred</li> <li>Must have basic computer knowledge, typing capability and proficiency in Microsoft Word and Outlook</li> <li>Knowledge of CM/DM principles, CCM Admin Modules, Care Advance system, Prism, NASCO and P&amp;P</li> <li>VDA, MEDCO, NCSW, Coaches Desktop, COSTCAI, HOTP database where applicable</li> <li>Knowledge of HIPAA, American Disability Act, Clinical ethics, COB rules and Medical Policy</li> <li>Familiarity with InterQual criteria, crises call interventions, evidence based guidelines and alternate care</li> <li>Knowledge of medical surgical principals, discharge planning, chronic diseases and clinical programs</li> <li>Knowledge of current trends in related fields</li> <li>Knowledge of benefits</li> <li>Effective written and verbal communication and feedback</li> <li>Effective organizational skills, ability to prioritize and flexibility</li> <li>Valid current Michigan driver&rsquo;s license and personal means of reliable transportation.</li> <li>Proof of auto liability coverage for nurses on-site</li> <li>Ability to review clinical data and develop benefit plan recommendations</li> <li>Travel to business locations as required.</li> </ul> <em>All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.</em>