Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate. • Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care. • Interacts with members/clients telephonically or in person. May be required to… Show more Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate. • Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care. • Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, work-sites, or physician’s office to provide ongoing case management services. (*) • Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client’s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate. (*) • Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person. (*) • Prepares all required documentation of case work activities as appropriate. (*) • Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes. (*) • May make outreach to treating physician or specialists concerning course of care and treatment as appropriate. (*) • Provides educational and prevention information for best medical outcomes. (*) • Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources. (*) • Conducts an evaluation of members/clients’ needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data. Show less

Charge NurseMother / BabySpecial Care Nursery

Staff Nurse - C4 Post Interventional Cardiology• Provide acute care to patients status post Percutaneous Coronary Interventions (PCI)/ or Percutaneous Trans-luminous Coronary Angioplasty (PTCA).• Telemetry Monitoring• Communication interdepartmentally, with physicians and across disciplinary teams• Pre-Op/Post-Op care• Patient/Family teaching• Documentation

• Design and support of Electronic Data Interchange of healthcare claims information.• Create and maintain documentation of new product offerings and identified defects.• Ensure adherence to HIPAA regulatory mandates and compliance of healthcare claims data.• Internal training of new development• System Matter Expert for Electronic Data Interchange (EDI)/ and electronic healthcare claims batch claim processing.

• Project lead for EDI initiatives, control & reporting, front end processing, and the federal employee query process on the Blue Cross & Blue Shields National Account Claims System (NASCO)• Focal point for system enhancement requests• System unit testing prior to production promotion• Liaison to the programmers for electronic and batch system enhancements