RN Case Management Coordinator (Maternity and/or NICU)
BlueCross BlueShield of South Carolina · South Carolina, United States · 1 mo ago
OTHRFull-time
We need to output HTML fragment with sections: About the role? The posting includes Summary, Description, Location, What You’ll Do, To Qualify For This Position..., We Prefer That You Have..., Our Comprehensive Benefits Package..., What We Can Do For You..., What To Expect Next..., EEO etc. We must remove boilerplate: EEO, equal-opportunity, scam-warning, navigation, legal, duplicated lines, application instructions. Also remove "What To Expect Next" (application instructions). Also remove "What We Can Do For You" maybe considered boilerplate? It's about diversity; could be considered EEO-ish but not exactly legal boilerplate; but it's generic. Might be considered boilerplate; but instruction: Remove cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate. "What We Can Do For You" is about diversity and inclusion; could be considered EEO-related. Safer to remove it. Also remove "What To Expect Next" (application instructions). Also remove EEO statement at end. Also remove duplicated lines.
We need sections only when posting has real specific content. Use for section headings: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule.
We need to map content.
We have Summary: description of role. Could be "About the role". Use
for section headings: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule.
We need to map content.
We have Summary: description of role. Could be "About the role". Use About the role
then
with summary. Location: full-time schedule Monday-Friday 8:30am-5:00pm EST, remote in South Carolina, may need to report on-site for trainings. That's Schedule (and maybe location). We have Schedule section if posting actually states them. Yes schedule given. So we can have
Schedule
withdetails. Responsibilities: "What You’ll Do" bullet list (actually paragraph with many sentences). We need to convert to
- items. The text is long; we can split into logical items. Must preserve all substantive information; not invent or summarize away detail. We need to break the paragraph into list items covering each duty. Could keep as one
but instruction: Use
- for any list of duties/requirements/benefits. The "What You’ll Do" is a list of duties, so we should make list.
We need to extract each duty sentence. Let's parse:
"Provides active care management, assesses service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans, to include member goals."
"Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions."
"Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits."
"Provides telephonic support for members with chronic conditions, high-risk pregnancy or other at-risk conditions that consist of: intensive assessment/evaluation of condition, at-risk education based on members’ identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement."
"Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans."
"May identify, initiate, and participate in on-site reviews."
"Serves as member advocate through continued communication and education."
"Promotes enrollment in care management programs and/or health and disease management programs."
"Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members."
"Performs medical or behavioral review/authorization process."
"Ensures coverage for appropriate services within benefit and medical necessity guidelines."
"Utilizes allocated resources to back up review determinations."
"Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.)."
"Participates in data collection/input into system for clinical information flow and proper claims adjudication."
"Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal)."
"Maintains current knowledge of contracts and network status of all service providers and applies appropriately."
"Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services."
That's many items.
We'll create
- for each.
Next: "To Qualify For This Position, You'll Need The Following" includes Required Education, Required Experience, Required Skills and Abilities, Required Software and Tools, Required License/Certificate. This is qualifications/requirements. We need sections: Requirements, Qualifications, Skills maybe. We have to decide.
We have "Required Education", "Required Experience", "Required Skills and Abilities", "Required Software and Tools", "Required License/Certificate". Also "Preferred Work Experience", "Preferred Education", "Preferred Skills and Abilities", "Preferred Licenses and Certificates". We could combine into Requirements (required) and Qualifications (preferred) or Skills. But instruction: Prefer a few substantive sections over many thin ones. So maybe we have sections: Requirements (covers required education, experience, skills, software, license), Qualifications (covers preferred). Skills maybe not needed separate if covered.
But we have separate headings allowed: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We can use Requirements for required, Qualifications for preferred, Skills maybe not needed if we include skills in Requirements. But we could still include Skills if we want to list skills separately. However we have many skill items; maybe better to put them under Skills section. But then we would have Requirements (education/experience/license) and Skills (skills and abilities). Qualifications for preferred.
Let's decide:
- Requirements: Required Education, Required Experience, Required License/Certificate, Required Software and Tools (maybe also include as part of requirements). Could also include required skills? But we have Skills section for skills.
- Skills: Required Skills and Abilities (list). Also maybe Preferred Skills and Abilities could go under Qualifications? But we could put preferred skills under Qualifications.
- Qualifications: Preferred Work Experience, Preferred Education, Preferred Licenses and Certificates.
- Benefits: Our Comprehensive Benefits Package.
- Schedule: Already have.
- Pay: Not mentioned, so omit.
We must not create Pay section if not stated.
Now we need to extract details.
Required Education: Associates in a job-related field. Degree Equivalency: 2 years job related work experience.
Required Experience: 4 years recent clinical in defined specialty area. Specialty areas include: oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedics, general medicine/surgery. Or, 4 years utilization review/case management/clinical/or combination; 2 of the 4 years must be clinical.
Required Skills and Abilities: list: Working knowledge of word processing software. Knowledge of quality improvement processes and demonstrated ability with these activities. Knowledge of contract language and application. Ability to work independently, prioritize effectively, and make sound decisions. Good judgment skills. Demonstrated customer service, organizational, and presentation skills. Demonstrated proficiency in spelling, punctuation, and grammar skills. Demonstrated oral and written communication skills. Ability to persuade, negotiate, or influence others. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion.
Required Software and Tools: Microsoft Office.
Required License/Certificate: An active, unrestricted RN license from the United States and in the state of hire OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC) OR, active, unrestricted licensure as counselor, or psychologist from the United States and in the state of hire (in Div. 75 only). For Div. 75 and Div. 6B, except for CC 426: URAC recognized Case Management Certification must be obtained within 4 years of hire as a Case Manager.
Preferred Work Experience: Prior experience as a lactation consultant. 7 years-healthcare program management.
Preferred Education: Bachelor's degree- Nursing
Preferred Skills and Abilities: Working knowledge of spreadsheet, database software. Thorough knowledge/understanding of claims/coding analysis, requirements, and processes.
Preferred Licenses and Certificates: Case Manager certification, clinical certification in specialty area.
Now Benefits: "Our Comprehensive Benefits Package Includes The Following We offer our employees great benefits and rewards. You will be eligible to participate in the benefits for the first of the month following 28 days of employment. Subsidized health plans, dental and vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more"
We need to put as
- items.
Now Schedule: "Location This position is full-time (40 hours/week) Monday-Friday from 8:30am-5:00pm EST and will be remote in South Carolina. The candidate may be required to report on-site for trainings, meetings, or other business needs."
We'll put that in Schedule section.
Now About the role: Use Summary paragraph.
Now we need to ensure we don't repeat job title as heading. Not needed.
Now produce HTML fragment.
We'll structure:
About the role
...
Responsibilities
- ... ...
Requirements
- Education: Associates in a job-related field (or 2 years job-related work experience equivalency).
- Experience: 4 years recent clinical experience in a defined specialty area (oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedics, general medicine/surgery) OR 4 years utilization review/case management/clinical or combination with at least 2 years clinical.
- License/Certificate: Active unrestricted RN license (state of hire) or active compact multistate RN license (NLC) OR active unrestricted licensure as counselor or psychologist (state of hire, Div. 75 only); for Div. 75 and Div. 6B (except CC 426) must obtain URAC recognized Case Management Certification within 4 years of hire.
- Software/Tools: Proficiency with Microsoft Office.
Skills
- Working knowledge of word processing software.
- Knowledge of quality improvement processes and demonstrated ability.
- Knowledge of contract language and application.
- Ability to work independently, prioritize effectively, and make sound decisions.
- Good judgment skills.
- Demonstrated customer service, organizational, and presentation skills.
- Demonstrated proficiency in spelling, punctuation, and grammar.
- Demonstrated oral and written communication skills.
- Ability to persuade, negotiate, or influence others.
- Analytical or critical thinking skills.
- Ability to handle confidential or sensitive information with discretion.
Qualifications
- Preferred experience: Prior experience as a lactation consultant; 7 years healthcare program management.
- Preferred education: Bachelor's degree in Nursing.
- Preferred skills: Working knowledge of spreadsheet and database software; thorough knowledge/understanding of claims/coding analysis, requirements, and processes.
- Preferred licenses/certifications: Case Manager certification; clinical certification in specialty area.
Benefits
- Eligibility for benefits starting first of the month following 28 days of employment.
- Subsidized health plans, dental and vision coverage.
- 401(k) retirement savings plan with company match.
- Life insurance.
- Paid
- items.
Now Schedule: "Location This position is full-time (40 hours/week) Monday-Friday from 8:30am-5:00pm EST and will be remote in South Carolina. The candidate may be required to report on-site for trainings, meetings, or other business needs."
We'll put that in Schedule section.
Now About the role: Use Summary paragraph.
Now we need to ensure we don't repeat job title as heading. Not needed.
Now produce HTML fragment.
We'll structure:
- for each.
Next: "To Qualify For This Position, You'll Need The Following" includes Required Education, Required Experience, Required Skills and Abilities, Required Software and Tools, Required License/Certificate. This is qualifications/requirements. We need sections: Requirements, Qualifications, Skills maybe. We have to decide.
We have "Required Education", "Required Experience", "Required Skills and Abilities", "Required Software and Tools", "Required License/Certificate". Also "Preferred Work Experience", "Preferred Education", "Preferred Skills and Abilities", "Preferred Licenses and Certificates". We could combine into Requirements (required) and Qualifications (preferred) or Skills. But instruction: Prefer a few substantive sections over many thin ones. So maybe we have sections: Requirements (covers required education, experience, skills, software, license), Qualifications (covers preferred). Skills maybe not needed separate if covered.
But we have separate headings allowed: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We can use Requirements for required, Qualifications for preferred, Skills maybe not needed if we include skills in Requirements. But we could still include Skills if we want to list skills separately. However we have many skill items; maybe better to put them under Skills section. But then we would have Requirements (education/experience/license) and Skills (skills and abilities). Qualifications for preferred.
Let's decide:
- Requirements: Required Education, Required Experience, Required License/Certificate, Required Software and Tools (maybe also include as part of requirements). Could also include required skills? But we have Skills section for skills.
- Skills: Required Skills and Abilities (list). Also maybe Preferred Skills and Abilities could go under Qualifications? But we could put preferred skills under Qualifications.
- Qualifications: Preferred Work Experience, Preferred Education, Preferred Licenses and Certificates.
- Benefits: Our Comprehensive Benefits Package.
- Schedule: Already have.
- Pay: Not mentioned, so omit.
We must not create Pay section if not stated.
Now we need to extract details.
Required Education: Associates in a job-related field. Degree Equivalency: 2 years job related work experience.
Required Experience: 4 years recent clinical in defined specialty area. Specialty areas include: oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedics, general medicine/surgery. Or, 4 years utilization review/case management/clinical/or combination; 2 of the 4 years must be clinical.
Required Skills and Abilities: list: Working knowledge of word processing software. Knowledge of quality improvement processes and demonstrated ability with these activities. Knowledge of contract language and application. Ability to work independently, prioritize effectively, and make sound decisions. Good judgment skills. Demonstrated customer service, organizational, and presentation skills. Demonstrated proficiency in spelling, punctuation, and grammar skills. Demonstrated oral and written communication skills. Ability to persuade, negotiate, or influence others. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion.
Required Software and Tools: Microsoft Office.
Required License/Certificate: An active, unrestricted RN license from the United States and in the state of hire OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC) OR, active, unrestricted licensure as counselor, or psychologist from the United States and in the state of hire (in Div. 75 only). For Div. 75 and Div. 6B, except for CC 426: URAC recognized Case Management Certification must be obtained within 4 years of hire as a Case Manager.
Preferred Work Experience: Prior experience as a lactation consultant. 7 years-healthcare program management.
Preferred Education: Bachelor's degree- Nursing
Preferred Skills and Abilities: Working knowledge of spreadsheet, database software. Thorough knowledge/understanding of claims/coding analysis, requirements, and processes.
Preferred Licenses and Certificates: Case Manager certification, clinical certification in specialty area.
Now Benefits: "Our Comprehensive Benefits Package Includes The Following We offer our employees great benefits and rewards. You will be eligible to participate in the benefits for the first of the month following 28 days of employment. Subsidized health plans, dental and vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more"
We need to put as
- for any list of duties/requirements/benefits. The "What You’ll Do" is a list of duties, so we should make list.
We need to extract each duty sentence. Let's parse:
"Provides active care management, assesses service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans, to include member goals."
"Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions."
"Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits."
"Provides telephonic support for members with chronic conditions, high-risk pregnancy or other at-risk conditions that consist of: intensive assessment/evaluation of condition, at-risk education based on members’ identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement."
"Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans."
"May identify, initiate, and participate in on-site reviews."
"Serves as member advocate through continued communication and education."
"Promotes enrollment in care management programs and/or health and disease management programs."
"Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members."
"Performs medical or behavioral review/authorization process."
"Ensures coverage for appropriate services within benefit and medical necessity guidelines."
"Utilizes allocated resources to back up review determinations."
"Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.)."
"Participates in data collection/input into system for clinical information flow and proper claims adjudication."
"Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal)."
"Maintains current knowledge of contracts and network status of all service providers and applies appropriately."
"Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services."
That's many items.
We'll create