Posted: Wednesday, November 8, 2017 3:33 AM
*** Sign on bonus available ***
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 peoples lives.
We understand the importance of finding a job that you truly enjoy : at a company that shares your values. Weve 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 13;
This position exists to support member needs across the continuum of care by leveraging member partnership, pre:service clinical utilization review, case and disease management processes, skill sets and tools. Care Advocacy Health Coach is responsible for answering customer questions pertaining to product information, benefits, claims resolution and eligibility in a call center environment. This position is a critical component of BCBSMN Medical Management team as the primary clinician providing condition and case management services to members.
:Serves as a customer advocate by identifying underlying customer needs and guiding them to appropriate programs and resources.
:Utilizes BCBSM customer service systems and tools to deliver Care Advocacy to designated accounts.
:Identifies opportunities for connecting members to group related benefits; e.g. Nurse Line, Employee Assistance Program, or other specialists with in BCBS Health Management Division.
:Educates members on the use of their health delivery system and tools.
:Participates as a resource to internal and external customers.
:Responsible for answering customer questions pertaining to product information, benefits, claims resolution and eligibility in a call center environment.
:Conducts comprehensive clinical assessments; gathers, analyzes, synthesizes and prioritizes member needs and opportunities.
:Develops a plan of care to address identified gaps in care and improve members health.
: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.
:Identifies relevant BCBSMN and community resources and facilitates warm program and network referrals.
:Monitors and evaluates plan of care over time.
:Ensures member data is documented according to BCBSMN application protocol and regulatory standards.
:Collaborates and coordinates with team members to facilitate day to day functions and enhance the overall operation of the department.
:Guides member through the Prior Authorization and Appeals process.
: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.
:Registered nurse with current MN license and with no restrictions.
:5 years relevant direct clinical care RN experience.
:Excellent customer service skills.
:Excellent communication skills.
:Excellent conceptual thinking skills.
:Excellent relationship management skills and the ability to quickly gain customer trust and confidence.
:Excellent organizational skills.
:Ability to thrive in ambiguity.
• Location: Minneapolis / St. paul
• Post ID: 27068802 minneapolis