Disab/WC Nurse CM II
Location: , Washington
Description: Horizon Blue Cross Blue Shield of New Jersey is at present recruited Disab/WC Nurse CM II right now, this occupation will be ordered in Washington. Further informations about this occupation opportunity please read the description below. Provides case management services for PIP and/or workers compensation cases with lost time, complex medical care, and/or high medical utilization. Ensures appropriateness and cost effectiveness of care, and optimal outcomes with complex and/or high volume caseloads. Coordinates cases with internal and external claim representatives, clients, employees, providers and attorneys. Provides guidance and serves as a resource to the Nurse Case Managers.
Education/Experience:
Prefers a Bachelor's degree
Requires minimum of five (5) years clinical experience
Requires minimum of three (3) years of case management, discharge planning or utilization review experience
Prefers minimum of one (1) year experience in medical/surgical, occupational medicine, rehabilitation, orthopedics, neurology and/or Workers Compensation or PIP experience
Additional licensing, certifications, registrations:
Requires a current New Jersey RN License
Prefers case management certification.
Knowledge:
Requires understanding of case management philosophy and process
Requires knowledge of health care delivery system
Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Lotus Notes; Should be knowledgeable in the use of intranet and internet applications.
Skills and Abilities:
Customer Focus
Communication & Organizational Skills
Problem Solving
Information/Knowledge Sharing
Adaptability/Flexibility
Interpersonal & Client Relationship Skills
Teamwork
Leadership
Responsibilities:
Performs initial and ongoing review with employees/claimants, coordinates medical care, and communicates with providers, clients, and attorneys as needed.
Authorizes inpatient and outpatient services, and reviews bills for appropriateness utilizing HCS guidelines.
Utilizes network providers to ensure appropriate treatment and services, where applicable.
Documents all activities on existing claims systems including describing progress, treatment, and recommendations for the ongoing case management according to HCS and client guidelines.
Attends in-services, seminars and meetings to maintain current knowledge level and licensure requirements.
Requires on-call coverage, on an as needed basis.
Serves as a backup to supervisor as needed.
Performs other duties as assigned by management.
- .
If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to Horizon Blue Cross Blue Shield of New Jersey.
Interested on this occupation, just click on the Apply button, you will be redirected to the official website
This occupation will be opened on: Wed, 18 Jul 2012 12:52:12 GMT
Apply Disab/WC Nurse CM II Here