Disease Management Case Manager I/I at Bcidaho

Posted in Other 14 days ago.

Location: Meridian, Idaho





Job Description:

Join Blue Cross of Idaho's growing Healthcare Operations team! This role is specific to our Condition Support (also known as Disease Management) program. In this role, case managers will effectively case-manage members utilizing a collaborative process. Work independently and under limited supervision. On a professional team working to help our members successfully manage chronic conditions such as; Asthma, Diabetes. Heart Failure, Chronic Obstructive pulmonary disease (COPD), and Coronary Artery Disease. Helping members understand how to follow their recommended treatment plan and make lifestyle changes to help them manage their condition through one on one coaching. RN applicants are preferred for this position and prior managed care or health plan experience is helpful.




What we are looking for:






Level I:







  • Nurse Candidates - Three years clinical nursing or case management to include medical and surgical inpatient or specialty care such as cardiovascular, endocrinology, oncology and respiratory. Previous health coaching or disease management is a plus.







  • Social Worker Candidates - Three years medical based social work with an emphasis on behavioral health, geriatrics, or chronically/terminally ill patients.







Education: Associates Degree in Nursing or Bachelor's Degree in Social Work; or equivalent work experience (Two years' relevant work experience is equivalent to one-year college)



Licenses/Certifications: Must hold one of the following:




  • Valid unrestricted Idaho Registered Nurse License




  • Valid unrestricted Idaho Social Worker License








Level II:







  • Nurse Candidates - Five years clinical nursing or case management to include medical and surgical inpatient or specialty care such as cardiovascular, endocrinology, oncology and respiratory. Previous health coaching or disease management is a plus.







  • Social Worker Candidates - Five years medical based social work with an emphasis on behavioral health, geriatrics, or chronically/terminally ill patients.







Education: Associates Degree in Nursing or Bachelor's Degree in Social Work; or equivalent work experience (Two years' relevant work experience is equivalent to one-year college)



Licenses/Certifications: Must hold one of the following:




  • Valid unrestricted Idaho Registered Nurse License




  • Valid unrestricted Idaho Social Worker License








What your day may look like:




  • Working telephonically with members that have chronic health conditions to establish and reach their health care goals. Utilizing motivational interviewing and other coaching to assist the member in making improvements to their health.




  • Conduct a thorough and objective evaluation of the members' current status including physical, psychological, environmental, and financial and health status expectations.




  • Evaluate the effectiveness of alternative care and ensure cost effective, quality care is maintained to meet Blue Cross of Idaho's (BCI's) program objectives.




  • Collaborate with Healthcare Operations and providers in order to achieve the most appropriate outcome while promoting the most cost effective use of available resources.




  • Maintain communication and collaborate with member, family, physicians and health team members.




  • Report quantifiable impact, quality of care, and/or quality of life improvements as measured against long and short-term goals.







We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.