Nurses
Allentown, PA
The leading health insurer in Central PA and the Lehigh Valley,
Capital BlueCross seeks these nursing professionals:
Case Manager -
We seek an RN with an active PA license or a Social Worker with a
Bachelor's Degree (or higher) plus 3 years of recent clinical
experience. Requires knowledge of AAHCC/URAC standards for case
management organizations and CMSA Standards of Practice for Case
Management, Act 68, NCQA, and ERISA; knowledge of managed care
principles/emerging health treatment modalities; a valid PA driver's
license with ability to travel using own vehicle; and strong PC
proficiency (Word/Access). Certification as a Case Manager; recent
managed care experience; geriatric focus/specialty; and/or Spanish
bilingual skills are preferred.
Concurrent Review Nurse -
You will evaluate targeted inpatient members to determine
appropriateness of level of care/treatment; monitor progression of
care to determine appropriate level of care/treatment with emphasis
on promoting quality care/cost effective outcomes; and coordinate
services for members by working in conjunction with external/internal
consulting treatment team to establish effective discharge plan
within benefit structure. Requires a PA licensed RN with 5-7 years
of clinical nurse experience working in acute care hospital; 3-5
years of utilization review/discharge planning experience; PC skills,
including Microsoft Word/Access proficiency; ability to demonstrate
openness, flexibility, problem solving, patience, and tact; plus a
valid PA driver’s license with ability to travel using own vehicle.
Knowledge of Act 68/NCQA/ERISA/CMS regulations as well as managed
care principles/emerging health treatment modalities is necessary.
Two years of managed care experience preferred.
Excellent compensation/benefits offered. Send resume to:
Email: human.resourcesLV@capbluecross.com
Capital BlueCross
1221 W. Hamilton St.
Allentown, PA 18102
For more information, call 610-820-2800
EOE
www.capbluecross.com