Medical and Behavioral Case Manager
- Employer
- Noridian Healthcare Solutions
- Location
- Fargo, North Dakota
- Salary
- Join our team!
View more
- Industry
- Healthcare
- Role
- Counselor / Therapist
- Job Type
- Long-Term
- Hours
- Full Time
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The Medical and Behavioral Case Manager reviews cases of members with acute or chronic conditions and collaborates with service providers, the patient and family, and internal resources (e.g. Medical Review) to establish the most effective treatment plan within the provisions of the policy. This position screens, assesses and develops case recommendations, educates patients and family, coordinates with providers and monitors and documents case(s) on an ongoing basis. This position is eligible for telecommuting after one year of employment.
Essential Functions
Knowledge, Skills and Abilities
Clinical Expertise
Advanced
Effective Interpersonal Communications
Advanced
Decision Making
Intermediate
Flexibility and Adaptability
Intermediate
Collaboration
Intermediate
Education Requirements
Required: Associate's
Preferred: Bachelor's
Field(s) of Study: Completion of RN program is required; BSN is highly preferred
Experience Requirements
Required: Minimum of 3 Years
Preferred: Minimum of 5 Years
Experience Details: Minimum of 3 years of clinical or related experience is required; previous case management experience is highly desirable.
Certification, Licensures & Registration Requirements
Title: North Dakota (ND) Registered Nurse (RN) License or RN License valid for work in ND
State or Agency: Board of Nursing
Equivalent combination of education, experience or training determined to be acceptable by Human Resources may be substituted, unless regulated by contract or program standards
Other Information
Job Posting Policy 6.05
New employees with Blue Cross Blue Shield of North Dakota will be eligible to apply for positions within their assigned department after successfully completing a 90-day review. For positions outside your department, you must attain a minimum of six months of service before you can apply.
Equal Opportunity Employment
Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individual with Disabilities, as well as Sexual Orientation or Gender Identity.
For questions, please email careers@bcbsnd.com
This job posting will be closed 4/30/2019 at 8:00AM CST. No further applications will be considered.
Essential Functions
- Identifies and assesses members with acute or chronic conditions for possible case management (CM) intervention. Develops, coordinates and monitors a plan of care for members with case management needs and educates both member and health care team of services allowed within the benefit plan.
- Develops a case management plan of care by initiating contact with the member/designated representative and their health care provider team after obtaining case management program consent from the member. Assesses initial and ongoing needs with the member/family, health care team and case manager by completing a thorough assessment of medical records and contact with providers and patient.
- Collaborates in identifying appropriate alternatives to the present care and providing assistance with identified needs by collaborating with the member and member’s health care team.
- Participates in discharge planning, networking with appropriate outside agencies and making appropriate referrals to alternative resources as needed.
- Documents case information and practices per CM policy and procedures and in accordance with CM accreditation standards.
- Verifies member benefit eligibility for alternative care for medical necessity and appropriateness and initiates the request for service.
- Throughout the case management process, collaborates with internal and external medical, utilization management and customer services teams as needed in the collaboration and coordination of the member’s care.
Knowledge, Skills and Abilities
Clinical Expertise
Advanced
Effective Interpersonal Communications
Advanced
Decision Making
Intermediate
Flexibility and Adaptability
Intermediate
Collaboration
Intermediate
Education Requirements
Required: Associate's
Preferred: Bachelor's
Field(s) of Study: Completion of RN program is required; BSN is highly preferred
Experience Requirements
Required: Minimum of 3 Years
Preferred: Minimum of 5 Years
Experience Details: Minimum of 3 years of clinical or related experience is required; previous case management experience is highly desirable.
Certification, Licensures & Registration Requirements
Title: North Dakota (ND) Registered Nurse (RN) License or RN License valid for work in ND
State or Agency: Board of Nursing
Equivalent combination of education, experience or training determined to be acceptable by Human Resources may be substituted, unless regulated by contract or program standards
Other Information
Job Posting Policy 6.05
New employees with Blue Cross Blue Shield of North Dakota will be eligible to apply for positions within their assigned department after successfully completing a 90-day review. For positions outside your department, you must attain a minimum of six months of service before you can apply.
Equal Opportunity Employment
Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individual with Disabilities, as well as Sexual Orientation or Gender Identity.
For questions, please email careers@bcbsnd.com
This job posting will be closed 4/30/2019 at 8:00AM CST. No further applications will be considered.
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