Minimum Two (2) years prior experience in case management as an RN or five (5) years as an RN in a health-related field is required. Must have current unrestricted Wyoming license as RN or higher. Must have an associate’s degree in nursing. Bachelor’s or Master’s degree in nursing preferred. Must have and maintain certification as Certified Case Manager (CCM). Active and unrestricted Wyoming license must be maintained in order to perform clinical functions.
Evaluate appropriateness of health care services based upon medical knowledge and condition of patient. Application of benefits available through the individual or group health policy as they related to the patient’s medical condition. The research of new procedures for determination of coverage under our products.
Review cases of members with acute or chronic conditions and collaborate with service providers, the patient and family, and internal resources 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 cases on an ongoing basis.
Minimum Two (2) years prior experience in case management as an RN or five (5) years as an RN in a health related field is required.
Access to PHI is broad due to job function requirement of responding to customer and provider appeals relative to claims payments, eligibility, contract benefits and any other inquiry.
Position summary shown may not include ALL of the necessary knowledge, skill, and ability requirements.
Note: Position summary shown may not include ALL of the necessary knowledge, skill, and ability requirements.
Blue Cross Blue Shield of Wyoming
EOE M/F/Vet/Disabled Employer