RN Care Manager
Key Skills for This Role
Full Job Posting
Skills
- Strong communication skills and the ability to positively interact with customers, peers, leadership, family members, caregivers, visitors, contracted agencies/personnel and the general public.
- Superior clinical process, critical thinking, and problem-solving skills; and ability to handle critical situations.
- Excellent written, oral communication, listening, and organizational skills.
- Ability to use computer system while conversing telephonically
- Able to demonstrate strong customer service skills, including tact and diplomacy, both in person and telephonically when communicating with internal and external customers
- Ability to appropriately prioritize workload and assignments and perform accurate, detailed and timely completion of assigned duties.
- Ability to work autonomously and as part of an interdisciplinary team
- Demonstrates sound judgment that affirms the rights and responsibilities of Member’s, families, health care professionals and health care organizations.
- Ability to operate a personal computer (PC), including proficiency in Microsoft Office Products.
Knowledge
Knowledge of NCQA standards for Population Health Management for health plan accreditation, DMAA standards for disease management and CMSA Standards of Practice for Case Management, Act 68, , CMS and ERISA.
Maintains knowledge of evidence-based guidelines for chronic conditions/care management.
Knowledge of clinical and managed care principles and operations.
Knowledge of current and emerging medical treatment modalities and best practice guidelines with the ability to analyze and interpret medical and benefit coverage interrelationships.
Knowledge of adult learning principles, motivational interviewing, and intrinsic coaching techniques.
Experience
At least three (3) years’ recent/related experience; care management, home health, medical/surgical behavioral health, and/or critical care preferred. Health plan experience preferred. Additional experience related to specialized positions (Oncology, Transplant, Maternity, Behavioral Health) will also be considered..
Experience in health coaching and motivational interviewing techniques preferred.
Education and Certifications
Registered Nurse with active licensure in home state; additional state’s licensure as needed/required to meet customer needs
Certified Case Management certification within 2 years of employment.
Compact RN license preferred
Physical Demands
Ability to travel to provider, facility, employer group and/or member locations using own vehicle, if appropriate.
We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues, and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live
Requirements
- Strong communication skills and the ability to positively interact with customers, peers, leadership, family members, caregivers, visitors, contracted agencies/personnel and the general public.
- Superior clinical process, critical thinking, and problem-solving skills; and ability to handle critical situations.
- Excellent written, oral communication, listening, and organizational skills.
- Ability to use computer system while conversing telephonically
- Able to demonstrate strong customer service skills, including tact and diplomacy, both in person and telephonically when communicating with internal and external customers
- Ability to appropriately prioritize workload and assignments and perform accurate, detailed and timely completion of assigned duties.
- Ability to work autonomously and as part of an interdisciplinary team
- Demonstrates sound judgment that affirms the rights and responsibilities of Member’s, families, health care professionals and health care organizations.
- Ability to operate a personal computer (PC), including proficiency in Microsoft Office Products.
About Capital Blue Cross
Nonprofit health insurer serving members and employer groups in 21 Central Pennsylvania and Lehigh Valley counties.
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