Nancy Shields Email & Phone Number

Kansas City, Mo, Us

Leverages a multidisciplinary approach in all aspects of Utilization Management reviews using evidence-based clinical guidelines, minimally necessary information and a thorough understanding of member certificates and benefits, Provider networks and Contracts, as well as established protocols. Conducts medical necessity reviews to determine appropriateness of requested healthcare services. Acts as an empathetic advocate for members to ensure delivery of cost-effective high-quality care and an elevated member and provider experience. Duties include management responsibilities for the prior authorization team for Medicare Advantage, Commercial and Affordable Care Act lines of business, and vendor management for third-party vendor.

Kansas City, Mo, Us

Spira Care is an advanced primary care healthcare offering in the Kansas City market designed by Blue Cross and Blue Shield of Kansas City. At Spira Care, the experience is designed to provide members with an integrated healthcare experience. The Care Guide, RN is an integral role within the Care Team who fulfill key member-experience responsibilities by managing member interactions at Spira Care and assisting members with navigating through the complexities of healthcare to make the experience simple, personal and transparent. They will effectively leverage a myriad of skill sets to provide the member a seamless healthcare experience, blending administrative, educational and care coordination functions. Care Guide RNs work with members primarily in face to face settings but also on the phone; creating connections and care along the way.

Kansas City, Mo, Us

Responsible for performing patient care delegating patient care tasks and for supervision of other patient care staff. Responsible for coordinating the plan of care for a group of assigned patients and consulting with other members of the health care team when indicated to ensure optimal patient outcomes.

Kansas City, Missouri, Us

Sr.Clinical Consulting for Quality Reporting servoces, with primary responsibilities as the knowledge lead for both eligible providers and eligible hospital consulting teams. Established a consulting framework for leverage across the quality reporting group and created a central repository for documentation that ultimately helps drive consistency across all of our consulting implementation projects.

Kansas City, Missouri, Us

Design and development of content and functional requirements for clinical quality measure, to enhance patient safety and improve clinical outcomes and help clients meet regulatory compliance and financial incentives for eligible professionals and hospitals. Other activities include: supporting the consulting processes including demo support, collaborating with clients on enhancements to our current solutions, and writing and reviewing supporting collateral.

Kansas City, Missouri, Us

Development of test plans and testing medical software content and define and execute test plans as required by organizational needs. Develop supporting knowledge framework to manage ongoing clinical content development, dissemination, and updates of knowledge content and utilizes knowledge of various clinical settings to organize content as appropriate to the workflow needs.

Board Certified Registered Nurse, Registered Nursing/Registered Nurse

Education record