About Blue Cross
At Blue Cross and Blue Shield of Minnesota, we are developing industry-leading strategies every day that make a healthy difference in people’s lives. Blue Cross has a legacy of improving health through innovation because we believe that everyone should have the opportunity to live the healthiest life possible. Chartered in 1933 as the state’s first health plan, we’ve been serving the health care needs of Minnesotans for more than 80 years.
Blue Cross supports you with competitive pay and a comprehensive benefits package. Many Employee Resource Groups are active in the company, promoting inclusion and helping us meet the diverse needs of our workforce and our members. Join us, and enjoy a work environment where all employees are respected and valued — a workplace honored with a perfect score on the Human Rights Campaign Corporate Equality Index for 2017. Find your place at a company that cares.
The Care Management Clinical Lead is a critical component of BCBSM’s Behavioral Health team. The position is a blend of providing case review support and mentoring employees performing utilization management (UM) activities. The Care Management Clinical Lead is a subject matter expert as well as a coach. He or she partners with the Care Management Learning and Development (L and D) Team to follow–through on formal L and D interventions to ensure employee learning.
- Provide day to day support for Team members.
- Mentor, coach and fulfill role of "preceptor" for clinicians.
- May manage a designated (work) case load based on business demand to ensure team success.
- Provide performance feedback to Manager – it is the role and responsibility of the Manager to deliver performance management feedback to clinicians. The Clinical Lead role does not deliver performance management feedback to clinicians; this is the responsibility of the manager.
- Assist with clinician case assignments and consultations, trouble-shoot issues and questions and be the first level escalation for clinicians.
- Participate in special projects and groups as requested by the Manager.
- Maintains exceptional level of service at all points of customer and staff contact.
- Has a working knowledge of broad–based goals, regulations and accreditation requirements of assigned market segment(s).
- Facilitates the on-boarding process for new employees.
- Acts as a liaison with the Care Management Learning and Development team and Manager with the goals of supporting education and consistency in implementation of policy, procedure and regulatory requirements.
- RN with current and unrestricted MN license.
- 5 years relevant clinical experience.
- 1 years of managed care experience; e.g. case management, disease management, utilization management.
- Exceptional and demonstrated communication skills.
- Exceptional and demonstrated conceptual thinking skills.
- Exceptional and demonstrated relationship management skills.
- Proficient in PC applications required to support medical management.
- Forward-thinker with exceptional problem solving skills.
- Experience working with state and federal regulatory and compliance standards for commercial and/or government programs.
- Coding experience:
- International Classification of Diseases (ICD–10).
- Knowledge and Current Procedural Terminology (CPT).
- Healthcare Common Procedure Coding Systems (HCPCS).
- Outstanding telephonic skills.
- Mentoring, coaching experience.
- CCM (Certified Case Manager).
Blue Cross Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.
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Thank you for your interest in Blue Cross. Be part of a company that lets you be you — and make a healthy difference in people’s lives every day
Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.
Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association