Blue Cross Blue Shield Case Management Coordinator in Fargo, North Dakota

Requisition Number17-0465Post Date7/11/2017TitleCase Management CoordinatorCityFargoDescriptionJob Summary: The Medical and Behavioral Case Manager reviews cases of members with acute or chronic conditions and collaborates with service providers, the patient and family, and internal resources (e.g. Medical Review) to establish the most effective treatment plan within the provisions of the policy. This position screens, assesses and develops case recommendations, educates patients and family, coordinates with providers and monitors and documents case(s) on an ongoing basis.ESSENTIALFUNCTIONS* Identifies and assesses members with acute or chronic conditions for possible case management (CM) intervention. Develops, coordinates and monitors a plan of care for members with case management needs and educates both member and health care team of services allowed within the benefit plan. * Develops a case management plan of care by initiating contact with the member/designated representative and their health care provider team after obtaining case management program consent from the member. Assesses initial and ongoing needs with the member/family, health care team and case manager by completing a thorough assessment of medical records and contact with providers and patient.* Collaborates in identifying appropriate alternatives to the present care and providing assistance with identified needs by collaborating with the member and member's health care team. * Participates in discharge planning, networking with appropriate outside agencies and making appropriate referrals to alternative resources as needed.* Documents case information and practices per CM policy and procedures and in accordance with CM accreditation standards.* Verifies member benefit eligibility for alternative care for medical necessity and appropriateness and initiates the request for service.* Throughout the case management process, collaborates with internal and external medical, utilization management and customer services teams as needed in the collaboration and coordination of themember's care.KNOWLEDGE, SKILLS ANDABILITIESClinical Expertise Advanced Effective Interpersonal Communications Advanced Decision Making Intermediate Flexibility and Adaptability Intermediate Collaboration Intermediate RequirementsJob Summary:The Medical and Behavioral Case Manager reviews cases of members with acute or chronic conditions and collaborates with service providers, the patient and family, and internal resources (e.g. Medical Review) to establish the most effective treatment plan within the provisions of the policy. This position screens, assesses and develops case recommendations, educates patients and family, coordinates with providers and monitors and documents case(s) on an ongoing basis.ESSENTIALFUNCTIONS* Identifies and assesses members with acute or chronic conditions for possible case management (CM) intervention. Develops, coordinates and monitors a plan of care for members with case management needs and educates both member and health care team of services allowed within the benefit plan. * Develops a case management plan of care by initiating contact with the member/designated representative and their health care provider team after obtaining case management program consent from the member. Assesses initial and ongoing needs with the member/family, health care team and case manager by completing a thorough assessment of medical records and contact with providers and patient.* Collaborates in identifying appropriate alternatives to the present care and providing assistance with identified needs by collaborating with the member and member's health care team. * Participates in discharge planning, networking with appropriate outside agencies and making appropriate referrals to alternative resources as needed.* Documents case information and practices per CM policy and procedures and in accordance with CM accreditation standards.* Verifies member benefit eligibility