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RN Specialist Cmplx CM Job

Date: Jan 9, 2019

Location: Eagan, Minnesota, US, 55122

Company: Blue Cross and Blue Shield of Minnesota

About Blue Cross



For more than 80 years, Blue Cross and Blue Shield of Minnesota has worked to improve the health of all Minnesotans. As a nonprofit organization, we have a long history of making a healthy difference in people’s lives and of giving back to the communities we serve. In particular, our industry-leading commitment to veterans, service members and their families helped us to be named the first and only Beyond the Yellow Ribbon health plan company in Minnesota.



We make it easy for you to support veterans groups and other community organizations by providing 20 hours of volunteer paid time off each year — in addition to regular paid time off. The dedication of Blue Cross volunteers has earned us recognition for running one of the most successful corporate food drives in the state; donating nearly 1,500 volunteer hours at Habitat for Humanity worksites; and growing more than 750 pounds of fresh produce at our onsite Community Giving Gardens. Find your place at a company that cares about veterans, our employees, our members and our communities.


Description Summary

Utilizing key principles of case management, the RN Specialist will research and analyze the member’s health needs and health care cost drivers and will work closely with an interdisciplinary care team to ensure members have an effective plan of care that leads to optimal, cost-effective outcomes. Leveraging clinical expertise, strong critical thinking skills and a keen business sense, the RN Specialist will work closely with the member and their family to avoid unnecessary hospitalizations and emergency department utilization, optimize site of care whenever possible, and ensure evidence-based treatment is being applied. An experienced case manager with managed care experience will be successful in this role.


Accountabilities


  1. Receives referral for member identified with high cost, complex medical conditions and telephonically outreaches to the member, family and providers to engage in complex case management program.

  2. Conducts clinical assessments with members and providers utilizing motivational interviewing; gathers, analyzes, synthesizes and prioritizes member needs and opportunities based upon the clinical assessment and research and collaborates with the interdisciplinary care team to develop a comprehensive plan of care.

  3. Collaborates and communicates with the health care team; e.g. member, family, designated representative, health care provider on a plan of care that produces positive clinical results and promotes high–quality, cost effective outcomes.

  4. Identifies relevant BCBSMN and community resources and facilitates program and network referrals.

  5. Monitors, evaluates, and updates plan of care over time.

  6. Ensures member data is documented according to BCBSMN application protocol and regulatory standards.

  7. Maintains outstanding level of service at all points of customer contact.

  8. Understands the strategic and financial goals of the department, complex care management teams, and the enterprise

  9. Knowledgeable of health plan operations (e.g. networks, eligibility, benefits)

  10. Promotes innovative solutions to improve day to day functions and enhance the overall operation of the department.

  11. Collaborates with interdisciplinary care team to develop a comprehensive plan of care to identify key strategic interventions to address member’s needs and health care cost drivers.

  12. Engage providers telephonically in reviewing and understanding treatment plans, including alignment with benefits and medical reimbursement policies to facilitate optimal treatment plans, care coordination, and transition of care between settings. 

  13. Identifies and implements cost saving opportunities to ensure optimal and cost-effective health outcomes.


Requirements

•           Registered nurse with current MN license and with no restrictions



•           5 years relevant clinical care experience



•           CCM Certificate, or ability to obtain within 1 year of starting in the position



•           Excellent telephonic skills  



•           Keen business skills



•           Excellent communication skills



•           Excellent conceptual thinking skills



•           Excellent relationship management skills



•           Excellent organizational skills



•           Computer application proficiency



•           Strong resiliency and flexibility skills



•           Excellent research, analytical, and creative problem-solving skills



•           Flexibility to work varied hours


Preferred Requirements


  • 2+ years of managed care experience; e.g. case management/health coach, utilization management and/or auditing experience (may be included in the 5 years relevant clinical experience)


FLSA Status

Exempt


Blue Cross Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.



 



Make a difference



Thank you for your interest in Blue Cross. Be part of a company that lets you be you — and make a healthy difference in people’s lives every day



Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.



Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association


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