Case Manager/Maternity
Bcidaho

Meridian, Idaho

This job has expired.


Join Blue Cross of Idaho's growing Healthcare Operations team! In this role, case managers will effectively care-manage members utilizing a collaborative process. Assess, plan, implement, monitor, and evaluate the options and services required to meet an individual's health needs using communication and available resources to promote quality, cost-effective outcomes.

What we are looking for in Case Manager:

Associate Level:

  • Nurse Candidates - Three years clinical nursing or care management in Obstetric Clinic or Labor and Delivery, or other Maternity Management experience
  • Social Worker Candidates - Three years of care management in Obstetric Clinic or Labor and Delivery, or other Maternity Management experience

Education: Degree/Diploma in Nursing; OR Master's degree in Social Work (LMSW)

Certifications/Licenses: Valid unrestricted Idaho Registered Nurse License (RN); OR Valid unrestricted Idaho Social Worker License (LMSW)

Intermediate Level:
  • Nurse Candidates - Five years clinical nursing or care management in Obstetric Clinic or Labor and Delivery, or other Maternity Management experience to include one year of Managed Care/Health Insurance experience
  • Social Worker Candidates - Five years of care management in Obstetric Clinic or Labor and Delivery, or other Maternity Management experience to include one year of Managed Care/Health Insurance experience

Education: Degree/Diploma in Nursing; OR Master's degree in Social Work (LMSW)

Certifications/Licenses: Valid unrestricted Idaho Registered Nurse License (RN); OR Valid unrestricted Idaho Social Worker License (LMSW)

What your day may look like:
  • Plan, implement, and evaluate appropriate health care services in conjunction with the physician treatment plan either on-site or telephonically
  • Conduct a thorough and objective evaluation of the members' current status including physical, psychological, environmental, and financial and health status expectations.
  • Evaluate the effectiveness of alternative care and ensure cost effective, quality care is maintained to meet Blue Cross of Idaho's (BCI's) program objectives.
  • Collaborate with Healthcare Operations and providers in order to achieve the most appropriate outcome while promoting the most cost effective use of available resources.
  • Maintain communication and collaborate with member, family, physicians and health team members.
  • Report quantifiable impact, quality of care, and/or quality of life improvements as measured against long and short-term goals.

Knowledge, Skills and Abilities (KSAs):
  • Managed care delivery systems
  • Utilization management
  • Care Coordination/Case Management
  • Quality Improvement (QI)
  • National Commission on Quality Assurance (NCQA) accreditation standards
  • Verbal & written communication
  • Good decision-making
  • Independent & critical thinking
  • Ability to handle assigned caseload in a quality and cost-effective manner
  • Respond to families in crisis and assess coping skills
  • Maximize discharges to the highest level of independence
  • Establish and maintain a collaborative relationship with contracting facilities and physicians
  • Connect with diverse audiences
  • Give and receive constructive feedback in a team environment

Preferred Requirements:
  • NICU (Neonatal Intensive Care Unit)

Reasonable accommodations

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.


This job has expired.

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