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| About Our
Company
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| Highmark Inc.
is among the nation's leading health insurers and is the
largest health insurance company in Pennsylvania based
on membership. An independent licensee of the Blue Cross
and Blue Shield Association, Highmark is driven by a
more than 70-year mission to provide access to
affordable, quality health care enabling individuals to
live longer healthier lives. Recognized as one of the
100 Best Places to Work in Pennsylvania for 2009,
Highmark Inc. is an equal opportunity employer who
strives to capitalize on the strengths of individual
differences and the advantages of an inclusive
workplace. Qualified applicants will receive
consideration for employment without regard to race,
color, ethnicity, age, sex, marital status, religion,
creed, national origin, disability, veteran's status,
sexual orientation or any other category protected by
applicable federal, state or local laws.
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| Job
Responsibilities Summary
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| This position
is responsible for the following:
Providing telephonic and/or on-site case management
services to members
Facilitating care co-ordination
Supporting member self-care, self- management, and
enabling independence
Identifying high risk members, promoting education,
health and wellness
Understanding Highmark lines of business, products, and
benefits as they pertain to case management
Identification and reporting of quality of care issues
via established processes.
Collaborating with internal departments and external
providers to facilitate provision of case management
services
Identifying and recommending opportunities for case
management process and system improvements
Implementation of case management processes in a manner
that assures compliance with all applicable federal,
state, regulatory and accrediting bodies: NCQA, URAC,
DOH, DOL, CMS etc.
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| Required
Qualifications
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| Education/
Work Experience
5 years clinical experience which includes at least 2
years full time equivalent experience providing direct
clinical care to the consumer.
1 year experience in utilization review or a case
management related activity
Licenses or Certifications:
Current Pennsylvania Registered Nurse license
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| Preferred
Qualifications
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| Education*:
Bachelor's Degree in Nursing or related field
Licenses or Certifications:
Case Management Certification (CCM)
Work Experience
Miscellaneous
Proficiency in utilizing PC applications
Excellent verbal and written communication skills
Excellent customer service skills
Knowledge of community resources
Demonstrated ability to handle multiple priorities
Demonstrated comfort level with member teaching
Demonstrated ability to act as a change agent to engage
members
Knowledge of federal and state insurance industry
regulations
Ability to work independently with minimal supervision
Ability for occasional travel
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