RN Care Management Clinical Lead Job

About Blue Cross



For more than 80 years, Blue Cross and Blue Shield of Minnesota has worked to improve the health of all Minnesotans. As a nonprofit organization, we have a long history of making a healthy difference in people’s lives and of giving back to the communities we serve. In particular, our industry-leading commitment to veterans, service members and their families helped us to be named the first and only Beyond the Yellow Ribbon health plan company in Minnesota.



We make it easy for you to support veterans groups and other community organizations by providing 20 hours of volunteer paid time off each year — in addition to regular paid time off. The dedication of Blue Cross volunteers has earned us recognition for running one of the most successful corporate food drives in the state; donating nearly 1,500 volunteer hours at Habitat for Humanity worksites; and growing more than 750 pounds of fresh produce at our onsite Community Giving Gardens. Find your place at a company that cares about veterans, our employees, our members and our communities.


Description Summary

$2,000 Sign on Bonus! The Care Management Clinical Lead is a critical component of BCBSM’s Health Services team. The position is a blend of providing case review support and mentoring employees performing utilization management (UM) activities. The Care Management Clinical Lead is a subject matter expert as well as a coach. He or she partners with the Care Management Learning and Development (L and D) Team to follow–through on formal L and D interventions to ensure employee learning.


Accountabilities


  1. Provide day to day support for Team members.

  2. Mentor, coach and fulfill role of "preceptor" for clinicians.

  3. May manage a designated (work) case load based on business demand to ensure team success.

  4. Provide performance feedback to Manager – it is the role and responsibility of the Manager to deliver performance management feedback to clinicians. the Clinical Lead role does not deliver performance management feedback to clinicians; this is the responsibility of the manager.

  5. Assist with clinician case assignments and consultations, trouble-shoot issues and questions and be the first level escalation for clinicians.

  6. Participate in special projects and groups as requested by the Manager.

  7. Maintains exceptional level of service at all points of customer and staff contact.

  8. Has a working knowledge of broad–based goals, regulations and accreditation requirements of assigned market segment(s).

  9. Facilitates the on-boarding process for new employees.

  10. Acts as a liaison with the Care Management Learning and Development team and Manager with the goals of supporting education and consistency in implementation of policy, procedure and regulatory requirements.


Requirements


  • RN with current and unrestricted MN license.

  • 5 years relevant clinical experience.

  • 1 years of managed care experience; e.g. case management, disease management, utilization management.

  • Exceptional and demonstrated communication skills.

  • Exceptional and demonstrated conceptual thinking skills.

  • Exceptional and demonstrated relationship management skills.

  • Proficient in PC applications required to support medical management.

  • Forward-thinker with exceptional problem solving skills.

  • Experience working with state and federal regulatory and compliance standards for commercial and/or government programs.


Preferred Requirements


  • Coding experience:

    • International Classification of Diseases (ICD–10).

    • Knowledge and Current Procedural Terminology (CPT).

    • Healthcare Common Procedure Coding Systems (HCPCS).



  • CCM (Certified Case Manager).

  • Outstanding telephonic skills.

  • Mentoring, coaching experience.


FLSA Status

Exempt

Blue Cross Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.



 



Make a difference



Thank you for your interest in Blue Cross. Be part of a company that lets you be you — and make a healthy difference in people’s lives every day



Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.



Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association

Company
Blue Cross Blue Shield of Minnesota
Posted
04/06/2018
Type
Full time
Location
Eagan, Minnesota 55122, US