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Care Managment Nurse Consultant I

Location:	Independence MO 64056 US
Pay:	$46,149.00 - $49,149.00 Annually
Employment Type:	Employee
Work Schedule:	Full-Time
Travel:	No Travel
Industry:	Insurance

Category:	Insurance-Healthcare
Experience Required:	Yes
Manages Others:	No
Degree Required:	Yes
Security Clearance Required:	No
Start Date:	7/1/2010
End Date:	7/1/2010
Closing Date:	7/9/2010

Description

EOE M/F/D/V

Number of positions: 5

Duties Include....

1. Evaluates information regarding prospective case management members referred by providers of medical care, utilization review vendors, members, and Customer Service and Claims staff to determine whether medical case management intervention is necessary to meet the members physical and psychological needs. When appropriate, educates members about accessing services, in-network use, national guidelines for care, and self-management skills and strategies.

2. Authorizes initiation of medical case management services and specialized program services for members and unique populations. Develops interventions designed to meet member or population desired outcomes. Assesses program/project effectiveness.

3. Facilitates appropriate use of resources and coordinates necessary services to improve health status and impact the cost of care. Identifies member needs for community resources and refers to Care Management Resource Consultant as appropriate. Identifies other resource needs; including mental health and substance abuse and refers to appropriate internal and external resources, as appropriate. Redirects members to the best performing network facilities when available. Negotiates rates for those services provided out of the network, as well as high dollar services provided in network, when appropriate. Audits medical provider and vendor invoices for compliance with negotiated agreements.

4. Researches new medical technologies and standards: reviews information from university hospital systems, the National Institutes of Health, and local community resources and approved websites. Encourages member and family empowerment through education and use of reliable resources.

ADDITIONAL DUTIES LISTED HERE: https://webaccounts.geha.com/Careers/careers.aspx?adata=qTRXt3alUhiby721fx6wJFvyUdyyhBvEGfzKkhGY4RmLlAndzS%2f2reUB81hGnoPedOid0W50P2ukxCcLk9YEXQ%3d%3d

Requirements

Education Requirements

Requires a Bachelors degree. Additional years of qualifying work experience may be considered in lieu of Bachelors degree.

Experience Requirements

Requires a current Missouri or Kansas RN license in good standing, and a minimum of two years of recent RN case management experience in a hospital or managed care setting, such as a health insurance environment and at least three years of nursing experience in a clinical setting.

ADDITIONAL DUTIES LISTED HERE: https://webaccounts.geha.com/Careers/careers.aspx?adata=qTRXt3alUhiby721fx6wJFvyUdyyhBvEGfzKkhGY4RmLlAndzS%2f2reUB81hGnoPedOid0W50P2ukxCcLk9YEXQ%3d%3d

TO APPLY; PASTE WEB ADDRESS INTO BROWSER: https://webaccounts.geha.com/careers/AppSelfService.aspx?adata=mRo2YdSGCq6IJVCleY7R%2fpxQgnQohk8hT8k%2bXaOLRwn70vqCWLj2Z4IaHQrrUuZh48tXiWWCFtIY6fU6v4Tj8uTCGuGp2jeptqpFpRyucscCfX4hPTDyvRisf%2b8ripAiGh1EojJfmYT5cKB%2bN57Su2X2EISJumVtYluMp0S6wftChhSQjL8Vyg%3d%3d

Contact Information
Government Employees Health Association 17306 East 24 Hwy Independence MO 64056 US http://www.geha.com Map to Job Contact More jobs from this employer

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