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RN Specialist- Medicare Advantage Job

Date: Dec 31, 2018

Location: Eagan, Minnesota, US, 55122

Company: Blue Cross and Blue Shield of Minnesota

 



About Blue Cross



 



Founded in 1933, Blue Cross and Blue Shield of Minnesota is the largest health plan in the state. We have more members, the largest network of providers and more products and services than any other plan in Minnesota. From the beginning, Blue Cross has been an innovator with a mission of making a healthy difference in people’s lives.



 



We understand the importance of finding a job that you truly enjoy — at a company that shares your values. We’ve made it easy to feel good about working at Blue Cross by encouraging volunteerism, valuing diversity and offering the flexibility you need to live a balanced life. We offer a suite of comprehensive medical and dental benefits as well as competitive pay, flexible work schedules and generous personal paid time off in addition to 20 hours of volunteer paid time off each year. We look forward to serving Minnesotans over the next 80 years and beyond. Join us and make a healthy difference through the work you do every day.


Description Summary

The RN Specialist is responsible for supporting member needs across the continuum of care by leveraging member and provider partnership, diagnosis/condition expertise, case and disease management processes, skill sets and tools.


Accountabilities


  1. Receives referral and leverages clinical and condition pathway knowledge for outreach stratification.

  2. Conducts clinical assessments with members and providers; gathers, analyzes, synthesizes and prioritizes member needs and opportunities.

  3. Collaborates and communicates with member, family, or designated representative on a plan of care that produces positive clinical results and promotes high-quality effective outcomes.

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

  5. Monitors and evaluates 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 divisional goals of assigned condition and market segment(s) including clinical and service availability.

  9.  Collaborates and coordinates with team members to facilitate day to day functions and enhance the overall operation of the department.

  10. 10 CEU’s per year within specialty area for knowledge base maintenance OR current certification in clinical specialty.    Based on learnings, provide educational sessions for care management teams.

  11. 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. 


Requirements


  • Registered nurse with current MN license and with no restrictions.

  • 5 years relevant direct clinical care experience.

  • 2 years of condition specific related experience within last 5 years (could be a part of 3 years).

  • Excellent communication skills.

  • Excellent conceptual thinking skills.

  • Excellent relationship management skills.

  • Excellent organizational skills.

  • Computer application proficiency.

  • Flexibility to work varied hours.


Preferred Requirements


  • 1+ years of managed care experience; e .g. case management/health coach, utilization management and/or auditing experience.

  • Outstanding telephonic skills.

  • Additional condition certification.


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


Nearest Major Market: Minneapolis

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