Care Manager

Blue Cross Blue Shield of MN

Eagan, MN, United States
$33.13 - $43.89 - $54.66 hourly; not specified; co...
2d onsite
Clinical data review
Provider performance analysis
Member satisfaction strategies
This job implements effective utilization management strategies including review of appropriateness of pre and post service health care services, application of criteria to ensure appropriate resource utilization, identification of referrals to a Health Coach/case management, and identification and resolution of quality issues

Job Summary

  • This job implements effective utilization management strategies including review of appropriateness of pre and post service health care services, application of criteria to ensure appropriate resource utilization, identification of referrals to a Health Coach/case management, and identification and resolution of quality issues.
  • Your Responsibilities include applying clinical experience, health plan benefit structure and claims payment knowledge to pre-service and retrospective reviews by gathering relevant and comprehensive clinical data through multiple sources.
  • We offer a comprehensive benefits package which may include: Medical, dental, and vision insurance, Life insurance, 401k, Paid Time Off (PTO), Volunteer Paid Time Off (VPTO), And more.

Matching Summary

This job implements effective utilization management strategies including review of appropriateness of pre and post service health care services, application of criteria to ensure appropriate resource utilization, identification of referrals to a Health Coach/case management, and identification and resolution of quality issues.

Salary

$33.13 - $43.89 - $54.66 Hourly; Not specified; Comprehensive benefits package

Skills & Requirements

Must-have

  • Clinical data review
  • Provider performance analysis
  • Member satisfaction strategies
  • Regulatory compliance
  • Claims payment knowledge

Nice-to-have

  • Collaborative interventions
  • Streamlining processes
  • Developing network rapport
  • Mentoring and coaching
  • Independent project completion

Key Requirements

  • Registered nurse or licensed behavioral health clinician
  • 3 years of related clinical experience
  • High school diploma or equivalency
  • Legal authorization to work in the U.S.

Work Rights

Legal authorization to work in the U.S.

Tailored Resume

Cover Letter