Case Management Triage Nurse

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information, please see: Are

you ready to make a difference? Choose to work for one of the most

trusted companies in Kansas.

• Why Join Us?
• Make a Positive Impact: Your work will directly contribute to

the health and well-being of Kansans.

• Family Comes First : Total rewards package that promotes the

idea of family first for all employees. Paid vacation and sick leave

with paid maternity and paternity available immediately upon hire

• Professional Growth Opportunities: Advance your career with

ongoing training and development programs.

• Dynamic Work Environment: Collaborate with a team of passionate

and driven individuals in a work environment that promotes

flexibility.

• Trust and Stability: Work for one of the most trusted companies

in Kansas with over 80 years of commitment, compassion and

community.

• Inclusive Work Environment: We pride ourselves on fostering a

workplace where everyone is valued and respected.

Benefits & Perks

• Base compensation is only one component of your competitive Total

• Incentive pay program (EPIP)
• Health/Vision/Dental insurance
• 6 weeks paid parental leave for new mothers and fathers
• Fertility/Adoption assistance
• 2 weeks paid caregiver leave
• 401(k) plan matching up to 5%
• Tuition reimbursement
• Health & fitness benefits, discounts and resources

primary and independent responsibility for the day-to-day activities of

researching, reviewing, processing, initial screening and triage of

members identified in the resource utilization programs as well as those

identified from any other source. Responsible for appropriate

identification and referral of members for potential case management

(CM) intervention. Responsible for testing discharge call outreach (DCO)

system development as needed. Responsible for conducting all activities

in compliance with State, URAC, HIPAA, DOL, CMS, and MTM goals and/or

guidelines.

"This position is eligible to work hybrid or onsite in accordance with

our Telecommuting Policy. Applicants must reside in Kansas or Missouri

or be willing to relocate as a condition of employment."

What you'll do

• Responsible for collaborating/coordinating with the case managers

triage potential members for CM.

• Responsible for coordinating CM identification activities with case

• Responsible for activities and collaboration with other areas of the

promote management of appropriate Blue Cross and Blue Shield of

Kansas (BCBSKS) members and achievement of other corporate goals

(e.g. HEDIS/Stars) which may involve participation of the CM area.

• Perform initial clinical review on referred cases. This may include

include any needed claims system or care coordination portal review

of member information/alerts as needed.

• Responsible for triage of referred cases to other programs or

management, other wellness programs, etc.)

• Conducts review of medical information without direct supervision.

require CM input or medical consultant expertise. All such

determinations must be made under limited time constraints.

• Assist in answering the general CM telephone lines for all lines of

Other Area Of The Company, Or Handle As Appropriate.

• Maintain appropriate activity level and case documentation to meet

• Responsible for performing all job functions within the scope of the

• Responsible for conducting resource utilization program activities

use, etc.).

• Responsible for delivering onsite training and orientation of new

What you need

Knowledge/Skills/Abilities**

Ability to communicate effectively, verbally, in writing, and via

telephone regarding confidential and sensitive issues while maintaining

a positive professional image.

Ability to problem solve using analytical reasoning and research.

Ability to self-direct, self-motivate, make independent decisions, and

prioritize/organize daily activities.

Awareness and understanding of current medical care practices.

Schedule could require alternative work hours, which