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Job Posting

Bi-Lingual Nurse Case Manager

Company: Blue Cross & Blue Shield of Rhode Island (BCBSRI)

Location

Job Description:

• Utilize the Case Management process of assessment, planning, implementation, coordination, monitoring, and evaluation on an ongoing basis. The process is dynamic and evolutionary, requiring continuous reassessments and revisions to the plan of care.

Hours will be either:

• (4) ten hour days, 8:15 am - 6:30 pm or
• 5 days, 10:15 am - 6:30 pm

REPRESENTATIVE JOB DUTIES (listed in order of importance)

• Screen referrals to identify members appropriate for assessment. Perform telephonic health assessments to identify members at risk who would benefit from case management services. Work with members, their families, and physicians to develop an individualized plan of care including member centered goals. Identify and utilize external, cultural/familial and community resources.
• Utilize a multi-disciplinary team approach to address opportunities to plan and coordinate care.
• Improve quality of life by assisting members in achieving an optimal level of wellness, promote independence through education, identify external resources, provide information regarding health care choices, and empower members to make informed decisions regarding their health.
• Promote member and provider satisfaction. Provide continuity and consistency of care by building positive relationships through collaboration with members, their families, and providers.
• Identify quantifiable, measurable outcomes, which include quality of life improvement, improved knowledge and behavior as well as performing cost benefit analysis.
• Advocate for members and their families to facilitate positive outcomes.
• Responsible for special projects as needed that will contribute to the quality improvement process and overall department efficiencies.

KNOWLEDGE, SKILLS & ABILITIES REQUIRED:

Knowledge of:

• Individual leadership skills.
• Adaptability and flexibility in a constantly changing environment.
• A high degree of professionalism.

Technical Skills:

• Basic PC skills.
• Highly developed interpersonal skills in order to interact effectively with internal and external customers.
• Persuasive skills required to negotiate, develop, influence, motivate, and move others through the stages of behavior change.
• Critical thinking and problem solving skills.

Ability to:

• Handle multiple priorities.
• Work independently as well as in a team environment.
• Function within the standards of practice for case management.
• Exercise sound judgment.
• Take initiative in finding solutions to difficult and/or sensitive problems.
• Perform other duties as assigned.

QUALIFICATIONS:

Minimum Education and Experience:

• Must have a current, unrestricted Rhode Island Nursing License. Bachelors Degree preferred.
• Certified Case Management (CCM) certification preferred or sitting for the exam when eligible.
• Five or more years experience in acute inpatient, rehabilitation, sub acute, skilled facility, home care, or managed health plan experience.
• Must be bilingual, Spanish preferred.

Preferred Education, Additional Qualifications and Experience:

• Minimum of one year experience in working in a managed care/health maintenance organization.
• Pediatric experience.

https://www.bcbsri.com/BCBSRIWeb/about/career_opportunities/index.jsp

At Blue Cross & Blue Shield of Rhode Island (BCBSRI), diversity and inclusion are central to our core values and strengthen our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity, affirmative action employer. We provide equal opportunities without regard to race, color, religion, gender, age, national origin, disability, veteran status, sexual orientation, gender identity or expression.

Please mention this ad on MinorityNurse.com when applying.

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