Posted: Friday, February 9, 2018 12:00 AM
For more than 80 years, Blue Cross and Blue Shield of Minnesota has been passionate about improving health. We provide quality, cost:effective health plans and innovative programs that make a healthy difference in people's lives. Blue Cross is the largest health plan based in Minnesota, covering nearly 3 million members in the state and across the country. We strive to help all Minnesotans overcome the barriers to good health.
We offer our employees a comprehensive benefits, compensation and total rewards package to keep you and your family healthy and to secure your financial future. Our Employee Resource Groups help us advance health equity while promoting a diverse and inclusive work environment. Join us and make a healthy difference in people's lives through the work you do every day. Together, well make Minnesota a better place to live - and a healthier one.
Description Summary 13;
The Access Management Program Specialist is a critical component of BCBSMs Medical Management team. The position is responsbile for supporting members enrolled in and the overall performance of the Restricted Recipient Program (RRP). This role functions as a part of a multidisciplinary team that is accountable for the overall program performance, and for our compliance to the core component of the Restricted Recipient program as defined by DHS and BCBSMN. This role includes education, service coordination, benefit management, auditing, monitoring and program referrals. The Access Management Program Specialist is a complex role with multiple challenges.
:Serves on clinical interdisciplinary team which identifies and approves restrictions or exceptions for those individuals that may benefit from the Restricted Recipient Program, or who are currently enrolled.
:Provides clinical oversight of the ongoing management of members in RRP.
:Uses critical and clinical thinking skills to review claims and other clinical data in order to determine appropriate adherence to program guidelines.
:Identifies potential clinical issues for escalation to the Behavioral Health Medical Director and RRP Clinical Governance.
:Accountable for overall program performance as evidenced by quality metrics and outcomes, and through internal and external audit performance.
:Coordinates care across members health care team as needed to minimize risk of harm to self or inappropriate usage of services. This could include coordination with primary care, pharmacies, community and county resources, and emergency room facilities.
:Acts as a point of contact for RRP program information for providers and facilities.
:Educates members on the appropriate usage of health care services that maximize their outcomes and refers members to other programs as needed.
:Maintains outstanding level of service at all points of customer contact.
:RN with MN license, with no restrictions.
:PHN certification or ability to obtain PHN certification within 3 months.
:5 years of relevant experience (Emergency Department, Public Health or Community Social Services, direct clinical experience with the Medicaid population).
:3 years of managed care experience; e.g. case management, utilization management.
:Process and/or project management experience.
:Outstanding communication skills, analytical thinking skills and task facilitation skills.
Preferred Requirements 13;
:Outstanding telephonic skills.
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, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability,
• Location: eagan, Minneapolis / St. paul
• Post ID: 29406202 minneapolis