BCN Advantage Care Coordinator-Care Transition to Home

<p>With more than 8,000 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. Interested in joining us?</p>

Southfield, MI

Blue Cross Blue Shield of Michigan

When you think of Blue Cross Blue Shield of Michigan 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="http://www.bcbsm.com/index/about-us/our-company.html" target="_blank"><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. http://www.bcbsm.com

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Coordinator

Competitive Total Compensation Package

Overview: <p><strong>Responsible for utilizing the nursing process in the development of treatment plans, with established goals, implementation, monitoring and evaluation of an assigned patient case loads in order to provide quality care appropriate to clinical needs.</strong></p>
Responsibilities: <p>Review and analyze referrals from a variety of sources for acceptance into the program. Evaluate patient needs, identify and recommend cost-effective health care options. Assure member health needs are consistent with nursing standards and practices, provide recommendations. Develop and monitor action plans established between member, family and/or designee and physician. Develop preauthorization review plans for the review of RN clinical cases. Make arrangements for DME supplies, medications, community resources and facilities. Educate patient and family and/or designee to processes, care practices, medication(s) and benefits. Review prescription drug coverage requests, transplant services, acute organ rejection episodes and/or requests for coverage. Prepare documentation, communicate findings and submit recommendations to medical policy, group representatives, and members of the health care team. (i.e. provider, subscriber, family). Coordinate the member appeals process for DOL, PA250/blended cases. Ensure clinical outcomes are met preventing future re-implantation. Review patient status, educate patient on self management and ensure appropriate levels of post care education are provided. Identify potential gaps in member discharge to be avoided through education, empowerment and/or motivational interviewing. Clinical review of claims to ensure that correct reimbursement occurs. Internal peer review for quality performance. May conduct patient home visits to guarantee that the setting is safe and medical services are delivered. Continues professional development by attending relevant educational programs at lease annually.</p>
Requirements: <p><strong>Departmental Preferences:</strong></p> <p>This position provides outreach and engagement to BCN Advantage members during and after a hospital admission. Focus is to assist with care coordination post discharge to reduce unnecessary readmissions back to the hospital within 30 days of discharge. Knowledgeable in chronic conditions and their treatment modalities is preferred. Ability to engage members telephonically. Good computer skills needed</p> <p><strong>Qualifications</strong></p> <p><strong>EDUCATION AND/OR EXPERIENCE</strong></p> <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>One (1) to three (3) years internal experience preferred</li> </ul> <p><strong>OTHER SKILLS AND ABILITIES:</strong></p> <ul> <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 educational assessments and learning strategies</li> <li>Knowledge of medical surgical principals, discharge planning, chronic diseases and clinical programs</li> <li>Ability to negotiate rates with par and non par providers for extra and non-contractual services</li> <li>Ability to develop financial plans</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>Daily travel to assigned on-site facility (Blue Care Connect Case Managers required)</li> <li>Valid current Michigan driver's license and personal means of reliable transportation for nurses on-site (Blue Care Connect Case Managers required)</li> <li>Proof of auto liability coverage for nurses on-site (Blue Care Connect Case Managers required)</li> </ul> <p><strong>CERTIFICATES, LICENSES, REGISTRATIONS</strong></p> <ul> <li>Registered Nurse with current unrestricted Michigan Registered Nurse license required</li> <li>Certification in Case Management (CCM) preferred</li> <li>Certification in Chronic Care Professional (CCP) preferred</li> <li>North American Transplant Coordinator Association certification preferred</li> </ul>