Posted: Wednesday, January 31, 2018 8:17 PM
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 13;
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.
:Receives referral and leverages clinical and condition pathway knowledge for outreach stratification.
:Conducts clinical assessments with members and providers; gathers, analyzes, synthesizes and prioritizes member needs and opportunities.
: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 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.
:Maintains outstanding level of service at all points of customer contact.
:Understands divisional goals of assigned condition and market segment(s) including clinical and service availability.
:Collaborates and coordinates with team members to facilitate day to day functions and enhance the overall operation of the department.
:10 CEUs per year within specialty area for knowledge base maintenance OR current certification in clinical specialty. Based on learnings, provide educational sessions for care management teamsClick Enter to preview the description of AccountabilitiesPreview
: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 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 13;
: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 13;
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, relig
• Location: eagan, Minneapolis / St. paul
• Post ID: 28881892 minneapolis