Clinical Nurse Case & Disease Management

• Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute
• Annual incentive bonus plan based on company achievement of goals
• Time away from work including paid holidays, paid time off and volunteer time off
• Professional development courses, mentorship opportunities, and tuition reimbursement program
• Paid parental leave and adoption leave with adoption financial assistance
• Employee discount program

• Completes member assessments by collecting and analyzing information across the seven domains of health and develops and implements individualized care plans with appropriate interventions in a culturally sensitive way. Uses standardized tools to complete assessments in the areas of clinical, functional, financial, support system, psychosocial and cognitive and environmental realms.
• Monitors effectiveness of plan of care by gathering sufficient information from relevant sources in order to intervene, as appropriate, to improve health outcomes. Determines appropriate intervals for monitoring plan of care. Utilizes internal, community and other healthcare resources to maximize outcomes.
• Acts as liaison between member, employer, providers, support system and BlueCross BlueShield of Kansas City. Works with multiple members of the healthcare team to foster continuity and coordination of care.
• Prioritizes interventions based on clinical need and readiness to change. Educates and works with members at different educational and health literacy levels. Utilizes clinical knowledge and critical thinking skills to individualize evidence based interventions. Assesses the member's need for education and tailors teaching to the member's knowledge level and learning style.
• Meets individual quality performance standards and annual targets for program performance as mutually agreed to by management team to maximize program value. Ensures compliance with applicable URAC and NCQA guidelines and state and federal regulations.
• Meets targets for program performance, such as monthly productivity and annual caseload requirements as mutually agreed to by management team to maximize program value.
• Schedules time effectively. Works with minimal supervision. Handles multiple projects simultaneously. Prioritizes work appropriately.

Minimum Qualifications

• Associate degree in nursing or any combination of education and experience providing the types and levels of knowledge, skills, and abilities required by the job.
• 3 years full-time direct patient care clinical experience in either of the following: transplant, oncology or medical/surgical
• Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
• Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Thorough knowledge of URAC and NCQA guidelines and state and federal regulations.
• Valid and active Registered nurse (RN) in Missouri and Kansas.
• Valid and active Registered nurse (RN) licensure in all 50 states and the District of Columbia initiated within 6 months and completed within 15 months of hire date.
• Case Management Certification within 3 years of hire date or within 3 years of transfer to Case Management role/department.

Preferred Qualifications

• Bachelor's degree in nursing with minimum of 5 years' experience, including at least three years' of case management and clinical transplant experience
• Intermediate level keyboarding skills
• Intermediate level knowledge of FACETS UM, CM and claims applications.
• Experience in working with Health and Wellness and programs or an understanding of wellness principles
• Thorough knowledge of NCQA guidelines and state and federal regulations
• Intermediate level knowledge of Milliman guidelines .
• Case Management Certification within 3 years of hire date or within 3 years of transfer to Case Management role/department.

Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.