Job Description

The Care Management Coordinator is responsible for working with the provider and member for the management of members with care coordination of health care needs. The Care Management Coordinator is accountable for providing clinical support to members by facilitating an appropriate Plan of Care for optimal health outcomes and facilitating the provider and member relationship for quality and cost-effective care. The Care Management Coordinator is responsible for working with the Provider and supporting the member with discharge planning, education, coordination of care needs and ensuring desired outcomes are achieved. The Care Management Coordinator is responsible for using established criteria to determine if inpatient admissions, outpatient services or home services are medically necessary. The Care Management Coordinator follows member cases through the review process determining medical necessity of continuation of services and the appropriateness of the treatment setting. The Care Management Coordinator is responsible for identification of high-risk members and those that meet criteria for referral to Quality Management.

Qualifications

• Bachelor’s degree in Nursing and RN licensure that is unrestricted in the state of Mississippi required. Master degree in Nursing preferred.
• Minimum two years of clinical experience required.
• Background in Utilization Review in the health care field is preferred.
• Excellent clinical thinking skills required.
• Excellent oral/written communication skills are required.
• Must have excellent organizational skills in order to successfully prioritize tasks and to ensure deadlines and benchmarks are consistently met.
• Must be able to work a flexible schedule when required.
• Must have above average PC skills and intermediate knowledge of Microsoft Office.

Blue Cross & Blue Shield of Mississippi is an Equal Opportunity Employer. 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. We offer a comprehensive benefits package that is worth approximately one-third of the salary compensation. Our benefits program is among the best in the health care field. We are looking for employees who can bring their experience, expertise and dedication to work for our customers.

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