See the world in fresh and vibrant ways. When you reimagine, perspectives change, potential is created and productive energy results. You can experience the difference new ways of thinking can make—for your career, your loved ones and your community—at Blue Cross and Blue Shield of Texas (BCBSTX). Blue Cross and Blue Shield of Texas is reimagining wellness for our state and looking for original thinkers who aren't afraid to make dynamic contributions. People destined to reimagine what's possible.
We currently have an immediate opportunity in Richardson for the following role:
Holistic Health Specialist - CDE needed Job ID: AH-1032747
This position is responsible for performing a variety of functions and is a single source of contact for members, health care personnel and all other entities involved in managing care. Identifies alternate treatment programs; consults with physicians, providers, members, and other resources to evaluate options and services required to meet an individual's health needs; promotes quality and cost effective outcomes; and serves as liaison to physicians and members.
Other functions also include determining member assignment of treatment, and pre-admission/post-discharge counseling for any acute condition. Establish relationship with the member. Handle immediate post discharge follow-up or until all short term care needs are met. Provide education/local resource information and encourage member (self) education. Functioning in a clinical care advisory role, assesses members for wellness education and disease management, introduces members to our website tools, educates members regarding wellness and specific conditions, and facilitates the coordination of care for identified members. Provide oversight to Holistic Health Coordinators.
Requirements: * Registered Nurse (RN) with current, valid, unrestricted license in state of operations * 2 years of clinical practice experience of direct clinical care to the customer * 1 year of experience in care management/condition management in a health insurance/managed care setting * PC proficiency to include Word, Excel, Lotus Notes and database experience * Clear and concise verbal and written communication skills * Familiarity of ancillary services including HHC, SNF, Hospice, etc. * Analytical skills * Decision making skills and sound clinical judgment to provide oversight of other staff * Incumbents with nursing licenses in positions/departments requiring multi-state licenses are required to obtain and maintain additional current, valid, and unrestricted applicable nursing licenses in other states as determined by management. Multi-state license fees will be provided by HCSC. Incumbents with other clinical licenses are not required to obtain multi-state licenses.
Preferred: * Solid Case Management experience, highly desired * Experience in managing complex or catastrophic health cases * Specialty clinical experience in intensive care medicine, orthopedic, NICU/pediatric, oncology, diabetic member management, obstetric (low to high risk maternity management) * Working toward or completion of CCM/CCP/CDE/MCG certification or Advanced degree * Knowledge of Milliman Guidelines or similar clinical guidelines * Knowledge of medical management policies and procedures.
We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.