Blue Cross and Blue Shield of Illinois, Montana, N Clinical Specialist in Albuquerque, New Mexico


JOB PURPOSE:This position is responsible for conducting medical management and health education programs for corporate customers to influence the members health choices and behaviors, to maintain cost containment, and to ensure appropriate services are being obtained and utilized. This position is accountable for determining if medical programs are needed (Case Management, Condition Management, Behavioral Health, Pharmacy, CCEI, LSM, SB); supporting the reporting of medical management outcomes; contributing to the development of job aids and program enhancements; and training/mentoring/providing oversight of clinical and non-clinical staffREQUIRED JOB QUALIFICATIONS:* Registered Nurse (RN) with 2 years direct clinical care to the consumer in a clinical setting, with current, valid, unrestricted clinical license in the state of operations (or reciprocity). For compact licensee changing permanent residence to state of operations, you must obtain active, unrestricted RN license in the state of operations within 90 days of hire. * 2 years Case Management experience in managing complex and catastrophic cases across a diverse adult population.* Knowledge of the health and wellness marketplace and employer trends.* Verbal and written communication skills including interfacing with internal staff/management and external vendors and community resources.* Analytical experience including medical data analysis.* PC proficiency to include Word, Excel, and Web based applications.* Organizational skills for maintaining a library of interventions and outcomes.* Knowledge of cost savings methodologies. & Incumbents with nursing licenses in positions/departments requiring multi-state licenses are required to obtain and maintain additional current, valid, and unrestricted applicable nursing licenses in other states as determined by management. Multi-state license fees will be provided by HCSC. Incumbents with other clinical licenses are not required to obtain multi-state licenses.PREFERRED JOB QUALIFICATIONS:* 3 years clinical experience.* Case Management Certification or other URAC recognized health care certification. * Patient education experience.* Bilingual in English and Spanish. * Experience facilitating meetings.* Experience mentoring or training other case management staff.

Location: NM - Albuquerque

Activation Date: Thursday, April 12, 2018

Expiration Date: Tuesday, May 1, 2018

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