Regional Nurse Program Coordinator
Location: Costa Mesa California
Description: Blue Shield of California is at the momment seeking for Regional Nurse Program Coordinator right now, this position will be placed in California. More details about this position opportunity kindly see the descriptions. Come join the hardest working, not-for-profit health plan in California and help deliver our mission to ensure all Californians have access to high-quality health! care at an affordable price. Blue Shield of California was founded in 1939 by a group of physicians who believed that everyone should be able to afford a visit to their doctor. More than 70 years later, Blue Shield now serves 3.3 million members, and is the first health plan in the nation to limit our annual net income to 2 percent of revenue and pledge to return the difference to our customers and the community with the board of directors' approval. We returned more than $475 million in 2011. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution. In 2012, we were named one of the World's Most Ethical Companies . Since 2005, the company has contributed more than $170 million to the Blue Shield of California Foundation, one of BusinessWeek's most generous corporate foundations .
Job Details
The Regional Nur! se Program Coordinator (RNPC), who will report to a nurse mana! ger, works in partnership with the Regional Medical Director (RMD) and/or the Accountable Care Organization (ACO) Medical Director, the Regional Program Manager, and regional network management and provider relations staff (the Regional Delegation Team) to achieve the Blue Shield of California (BSC) strategic goals of reducing inpatient bed days per thousand, achieving affordability, and improving quality of care. The RNPC/RMD relationship is analogous to the Advanced Practice Nurse/MD relationship.
The RNPC will be responsible for:
Teaching/mentoring medical groups and hospital care management staff in the following:
- UM (inpatient and outpatient)
- Complex case management
- ER interventions
- Pharmacy
- Gathering and interpreting data
- Process and performance improvement
- RN will provide onsite presence to medical groups and associated hospitals that have been identified as having excessive avoidable bed days. The onsite RN will provide concurrent review and case management support to the groups and hospitals in order to eliminate avoidable bed days.
- In coordination with the RMD and Program Manager, assess:
- Medical groups' will and skill, readiness to change, and existence of appropriate infrastructure to support care management best practices
- Management/monitoring of progress of medical groups on corrective action plans
- In coordination with RMD and Program Manager, work with medical groups & hospital clinical staff to design, implement, and evaluate new programs and best practices
Bachelor of Science in Nursing (BSN) required. Master's level preparation desirable
5 years clinical exper! ience required
3 or more years experience in utilization management!
3 or more years experience in hospital, group, or health plan care management
2 or more years experience working in care management team
Prior management experience preferred
Prior experience in IPA/Medical Group delegation oversight strongly preferred
Demonstrated proficiency with Excel, Word, and PowerPoint
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Blue Shield of California is committed to remaining a drug-free work place. All positions require a pre-employment background investigation and drug screen. Blue Shield of California is an Equal Opportunity Employer.
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If you were eligible to this position, please email us your resume, with salary requirements and a resume to Blue Shield of California.
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This position starts available on: Fri, 17 May 2013 20:15:37 GMT