Nurse Care Manager-Katie Beckett-Davidson
| Company | BlueCross BlueShied of Tennessee |
|---|---|
| Location | Nashville, TN, USA |
| Salary | $Not Provided – $Not Provided |
| Type | Full-Time |
| Degrees | Bachelor’s |
| Experience Level | Mid Level, Senior |
Requirements
- Registered Nurse (RN) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law.
- 3 years – Clinical experience required
- 5 years – Experience in the health care industry
- For Select Community & Katie Beckett: 2 years experience in IDD for Select Community is required
- Currently has a Certified Case Manager (CCM) credential or must obtain certification within 2 years of hire.
- For Select Community & Katie Beckett: In addition to CCM, Certification in Developmental Disabilities Nursing (CDDN) is required at hire, or must be attained within 3 years.
- Excellent oral and written communication skills
- PC Skills required (Basic Microsoft Office and E-Mail)
Responsibilities
- Manage a caseload of multiple complex pediatric members needs
- Conduct member visit including home visits by meeting timelines within the requirements set forth by our contract
- Perform new member visit and ongoing assessments
- Develop and maintain Person Centered Support Plans
- Collaborate with private insurance (TPL) and Medicaid to coordinate care to ensure that members needs are being met, and services are covered by the appropriate payor source
- Supporting utilization management functions for more complex and non-routine cases as needed
- Serving as a liaison between members, providers and internal/external customers in coordination of health care delivery and benefits programs
- Overseeing highly complex cases identified through various mechanisms to ensure effective implementation of interventions, and to ensure efficient utilization of benefits
- Performing the essential activities of case management: assessment: planning, implementation, coordinating, monitoring, outcomes and evaluation
- Digital positions must have the ability to effectively communicate via digital channels and offer technical support
Preferred Qualifications
- Qualified candidate will have pediatric experience preferably from an acute care setting, with demonstrated clinical expertise in caring for medically fragile children with complex medical and/or behavioral health needs.