Current, unrestricted Wyoming license as LPN, RN or APRN. Bachelor’s or Master’s degree in nursing preferred. Certified Case Manager (CCM) required for Case Management positions. No experience to three years of experience in case management, disease management, health care or health insurance.
Registered Nurses are hired from various professional disciplines, education and experience backgrounds for the purpose of ensuring a pool of talent for future staffing needs. As dictated by the needs of the company, duties of the Registered Nurse may fall under any of the following categories.
Utilization Management – 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 relate to the patient’s medical condition. Research new procedures for determination of coverage.
Case Management – Review cases of members with acute or chronic conditions and collaborate with providers, the patient and family, and internal resources to establish the most effective treatment plan within the provisions of the health policy. Screens, assesses and develops case recommendations; educates patients and family; coordinates with providers and monitors and documents cases on an ongoing basis.
Disease Management – Provide population-based approach to the clinical and quality management of chronic conditions. Identify individuals with chronic conditions, and through use of disease-specific interventions, attempt to alter the course of the disease.
No experience to three years of experience in case management, disease management, healthcare or health insurance. Job placement will be determined based on education and work experience.
Computer, electronic health care processing software, Microsoft Office, various on-line software, fax, copy and scanning machines, telephone
Works in an open office environment. Physical activities include, but are not limited to, keyboard and mouse manipulation, hand carrying items short distances to various other departments.
Access to Protected Health Information (PHI) will be limited to that which is necessary to carry out job duties outlined above.
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