Care Coordinator II

Location: Chicago, ILEducation Required: Not IndicatedExperience Required: Not IndicatedPosition Description:BASIC FUNCTION: 1) This position is responsible for performing concurrent review and case management activities in accordance with approved departmental guidelines; discharge planning and identifying alternate treatment programs for chronic or catastrophic cases while providing medically necessary cost effective services within the scope of the individuals benefit plan; applying Case Management principles in coordinating resources necessary to implement treatment options to meet the individuals health needs; and may serve as a preceptor for less experienced staff.JOB REQUIREMENTS: 1) Registered Nurse (RN), unrestricted license to practice in Illinois. 2) 3 years clinical practice experience. 3) 1 year Health Insurance/Managed Care experience. 4) Knowledge of UM/CM activities and standardized criteria set. 5) Knowledge of managed care and insurance industry. 6) Familiarity of ancillary services including HHC, SNF, Hospice, etc. 7) Verbal and written communication skills; analytical skills; sound clinical judgment. 8) PC proficiency to include Microsoft Word, Excel and Access. 9) Current IL drivers license. 10) Ability to travel.PREFERRED JOB REQUIREMENTS: 1) Working toward CM certification or advanced degree. 2) Experience managing complex or catastrophic cases. 3) Experience in Disease Management. 4) Knowledge of BCBSIL Medical Management policies and procedures. 5) Familiarity with medical guidelines (M&R, Interqual, etc.). 6) Preparation of cost analysis on extra contractual benefit requests..