Description

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic.


Blue Cross and Blue Shield of Minnesota

Position Title: RN Specialist Complex Case Management - Medicare Advantage
Location: Remote
Career Area: Health Services


About Blue Cross and Blue Shield of Minnesota

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us.

The Impact You Will Have

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.

Your Responsibilities

• 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.
• 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.
• 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.
• Identifies relevant BCBSMN and community resources and facilitates program and network referrals.
• Monitors, evaluates, and updates 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 the strategic and financial goals of the department, complex care management teams, and the enterprise
• Knowledgeable of health plan operations (e.g. networks, eligibility, benefits)
• Promotes innovative solutions to improve day to day functions and enhance the overall operation of the department.
• 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.
• 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.
• Identifies and implements cost saving opportunities to ensure optimal and cost-effective health outcomes.

Required Skills and Experience

• Registered nurse with current MN license and with no restrictions
• All relevant experience including work, education, transferable skills, and military experience will be considered.
• 5 years relevant clinical care experience
• CCM Certificate or ability to obtain within 3 years 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
• High school diploma (or equivalency) and legal authorization to work in the U.S.

Preferred Skills and Experience

• 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).

Compensation and Benefits:

Pay Range: $79,100.00 - $104,800.00 - $130,500.00 Annual

Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.

We offer a comprehensive benefits package which may include:

• Medical, dental, and vision insurance
• Life insurance
• 401k
• Paid Time Off (PTO)
• Volunteer Paid Time Off (VPTO)
• And more

To discover more about what we have to offer, please review our benefits page.

Role Designation

Remote

Teleworker

Role designation definition: Teleworking is working full time remote. Hybrid is a minimum of 2 days onsite. Onsite is full-time onsite.
Equal Employment Opportunity Statement

Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: talent.acquisition@bluecrossmn.com.

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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