Employment opportunity Blue KC

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4-7-11

Summary of Position:
Oversees day to day operations of Manage Care Specialists; triages at risk members to integrated health management programs; oversees referral processes between utilization management, case management and the disease state management programs; and facilitates training for Managed Care Specialists.

Supervisory Responsibilities (if applicable):
Supervises 10-15 Managed Care Specialists dedicated to care management programs.

Qualifications - The following qualifications are representative of the basic knowledge, skills and abilities required to perform this job at a satisfactory level. Reasonable accommodations may need to be made to enable individuals with disabilities to perform the essential functions:

Education and Years of Experience:
Associate's degree in nursing (bachelor's degree preferred) and 5-8 years of experience, including medical/surgical experience (direct patient care) and utilization, case or disease management experience, with at least one year of management experience preferred; or any combination of education and experience providing the types and levels of knowledge, skills, and abilities required by the job.

Certification, Licenses, Registrations Required:
RN license in Kansas and Missouri.
URAC-approved certification in case management preferred upon hire; and, required at the end of the third year after hire.

Salary Range

Grade 016 - $66,160 to $102,550

apply on line at www.bluekc.com For questions, please call Angela Norman at 816 395-2966.

4-7-11

Medicaid Special Programs Coordinator.

Summary of Position:
This position fulfills a contractual requirement with the State of Missouri Medicaid Managed Care program. Leads collaborative efforts with all local and state agencies as identified within the state of Missouri. Under the direction of the Blue Advantage Plan Administrator, identifies, designs, develops and oversees special programs related to health education, promotion, and health improvement of Medicaid beneficiaries. Guides Medicaid product improvement in utilization and health care resources by promoting solid clinical management programs.

Principal Challenges – List the most typical and/or most complex problems or challenges faced in performing the job:
* Dealing with details and complexity of State of Missouri Medicaid contract.
* Writing, analyzing, and interpreting reports in Business Objects and Crystal Reports from the EDW.
* Managing requests from auditors and providing information in the most effective manner.

Education and Years of Experience:
Minimum of one of the certifications, licenses, or registrations stated in the section immediately following (see Certification, Licenses, Registrations below for specific requirements and educational levels), with 3-5 years of experience in state and federal programs, program development to meet the needs of special populations, working with multiple constituent groups in program development and implementation, interpreting government regulations, and project management; or any combination of education and experience providing the types and levels of knowledge, skills, and abilities required by the job. Previous experience with Medicaid is preferred.

Certification, Licenses, Registrations Required:
Must be one of the following: Missouri licensed social worker; Registered nurse; Advanced practice nurse; Physician; Physician’s assistant; or have a Master’s degree in health services, public health or health care administration.

Salary Range

Grade 014 - $52,740 to $81,750

apply on line at www.bluekc.com For questions, please call Angela Norman at 816 395-2966.

4-7-11

Job Title: Clinical Nurse, Case/Dis Mgmt Department: Health and Wellness Solutions
Reports To: Director or Manager Grade: 14

Summary of Position:
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.

Essential Accountabilities - Other duties may be assigned:
* Completes member assessments by collecting and analyzing information across the seven domains of health and develops and implements individualized care plans with appropriate interventions in a culturally sensitive way. Uses standardized tools to complete assessments in the areas of clinical, functional, financial, support system, psychosocial and cognitive and environmental realms.
* Monitors effectiveness of plan of care by gathering sufficient information from relevant sources in order to intervene, as appropriate, to improve health outcomes. Determines appropriate intervals for monitoring plan of care. Utilizes internal, community and other healthcare resources to maximize outcomes.
* Acts as liaison between member, employer, providers, support system and BlueCross BlueShield of Kansas City. Works with multiple members of the healthcare team to foster continuity and coordination of care.
* Prioritizes interventions based on clinical need and readiness to change. Educates and works with members at different educational and health literacy levels. Utilizes clinical knowledge and critical thinking skills to individualize evidence based interventions. Assesses the member's need for education and tailors teaching to the member's knowledge level and learning style.
* Meets individual quality performance standards and annual targets for program performance as mutually agreed to by management team to maximize program value. Ensures compliance with applicable URAC and NCQA guidelines and state and federal regulations.
* Meets targets for program performance, such as monthly productivity and annual caseload requirements as mutually agreed to by management team to maximize program value. Schedules time effectively. Works with minimal supervision. Handles multiple projects simultaneously. Prioritizes work appropriately.

. Associate degree in nursing (bachelor's degree preferred) with at least 3 years full-time direct patient care clinical experience in medical/surgical, pediatrics, or obstetrics. At least 1 year of utilization review, disease management, and/or case management experience preferred.

Certification, Licenses, Registrations Required:
RN license in Missouri and Kansas.
apply on line at www.bluekc.com For questions, please call Angela Norman at 816 395-2966.