Harrisburg, PA
The leading health insurer in Central PA and the Lehigh Valley, Capital BlueCross
seeks these nursing professionals:
Maternity Case Manager -
To identify, enroll and provide case management services to eligible pregnant members;
perform case/risk assessment, prenatal education and medical/benefit evaluation;
prepare individualized plan of care; and perform ongoing case monitoring/review.
Requires an RN with a PA license and 3 years of recent clinical OB experience or a
health care professional with a Bachelor's (or higher) in a health related field or Case
Manager certification. Knowledge of AAHCC/ URAC standards for case management
organizations; CMSA Standards of Practice for Case Management; ACOG standards for
OB/Gyn services; Guidelines for Perinatal Care; managed care principles and emerging
health treatment modalities is necessary. Valid driver’s license and ability to travel using
own vehicle required.
Concurrent Review Nurse -
Will evaluate targeted inpatient members upon admission to determine appropriateness
of level of care/treatment; monitor progression of care with emphasis on promoting quality
care/cost effective outcomes; and coordinate services for members by working in conjunction
with consulting treatment team to establish effective discharge plan within benefit structure.
This PA licensed RN should possess 5-7 years of clinical nurse experience in an acute care
hospital setting; 3-5 years of experience in utilization review/discharge planning; knowledge
of managed care principles/emerging health treatment modalities and
Act 68/NCQA/ERISA/CMS regulations; PA driver’s license; and solid Access/MS
Word/communication skills. Two years of working in a managed care environment preferred.
Excellent compensation/benefits. EOE/AA.
Send resume to
Email: human.resources@capbluecross.com
Capital BlueCross
Staffing
Harrisburg, PA 17177-2211