Blue Cross and Blue Shield of Louisiana Care Management Onsite RN (New Orleans) in Metairie, Louisiana
We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross.
Please note that effective Jan. 4, 2022, Blue Cross and Blue Shield of Louisiana implemented a policy requiring any employee who enters any of our offices or who interacts in person with anyone for company business purposes to be fully vaccinated for COVID 19, unless legally entitled to a reasonable accommodation related to religious or medical exemptions. At this time, that policy is suspended and vaccination is not required to enter our facilities. Please note this is subject to change at any point in time to ensure compliance with company policy or government mandates and certain client facing roles may have separate protocols.
Residency in or relocation to Louisiana is preferred for all positions.
Serves as a central point of contact, whose goal is to effectively manage patients identified as high risk for health care complications, and improve their quality of life. Works collaboratively within dedicated practice sites, including but not limited to primary care offices and/or health care facilities. Utilizes interventions to ensure adherence to clinical guidelines, improve health outcomes, and reduce adverse events, such as unnecessary admissions, readmissions, and over utilization of healthcare services. Serves as an advocate in addressing social determinates of health, and facilitates coordination of care across all aspects of the health care system.
NATURE AND SCOPE
This role does not manage people
This role reports to this job: MANAGER, POPULATION HEALTH
Necessary Contacts: In order to effectively fulfill this position the incumbent must be in contact with:Benefits Administration, Medical Director, Underwriting, Group leaders, Delegated Vendors, Legal Department and other employees as needed, physicians/staff, hospital administrators/staff, providers, caregivers, subscribers, community resources.
- Bachelor's Degree in Business Administration, Healthcare, Computer Science or related degree required
4 years of experience in a clinical care setting required
Leadership experience preferred
Skills and Abilities
Requires the ability to work independently and anticipate needs to make decisions with minimal supervision, implement and evaluate appropriate healthcare services in conjunction with a physician treatment plan evaluating the effectiveness of alternate care services.
Utilizing a variety of data resources, have the ability to research and analyze contracts/cases/populations and make appropriate quality and cost effective decisions is required.
Experienced in use of behavioral interviewing techniques and theory required. Also must demonstrate excellent interpersonal, organizational, analytical, and telephonic skills.
Must demonstrate strong communication skills, including the ability to effectively explain/present claims information and procedures to persons with varied levels of insurance/benefits understanding.
Requires working knowledge of related software and office equipment.
Licenses and Certifications
Nursing\RN - Registered Nurse - State Licensure And/Or Compact State Licensure RN licensed to practice in Louisiana required
Health Services\LPN - Licensed Practical Nurse - State Licensure license to practice in Louisiana as well as 2 years of related experience can be used in lieu of degree.
Certified Professional in Health Care management, Chronic Disease Management Certification, or Case Management Certification or attainment 2 years required
Chronic Disease Management or Case Management Certification required
ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS
Provides focused oversight, monitoring, coaching and education to assist patients in managing their health conditions, prioritizing their healthcare needs, preventing complications, and navigating the healthcare system to minimize the potential for duplication of services, eliminate gaps and fragmentation in services provided, and avoid disruptions in care.
Works collaboratively with designated practices and/or facilities to determine targets for program performance, and utilize data analysis to determine effectiveness of the program.
Utilizes appropriate professional nursing judgment in application of contractual benefits and limitations, administrative directives, and claims policy in order to direct the appropriate course of action throughout the continuum of care and refer to appropriate resources to verify benefits
Assesses member’s status telephonically and/or face to face, utilizing behavioral interviewing techniques, collecting in-depth information in a culturally competent and confidential manner. Fosters a partnership with patients and caregivers by learning about the unique personality of each patient, including their learning style and preferences, and identifying personal goals.
Develops and implements a comprehensive individualized care plan, in collaboration with the primary care provider, which includes specific interventions and goal outcome measurement. Conducts case conferences with member, provider, and facilities as appropriate.
Identifies and accesses community resources that will enhance the patient’s care and well-being, such as respite care, community meals-on-wheels programs, alternate housing options, home and health assessments, medication and financial assistance.
Additional Accountabilities and Essential Functions
The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions
Perform other job-related duties as assigned, within your scope of responsibilities.
Job duties are performed in a normal and clean office environment with normal noise levels.
Work is predominately done while standing or sitting.
The ability to comprehend, document, calculate, visualize, and analyze are required.
An Equal Opportunity Employer
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In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.
Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.
Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.
JOB CATEGORY: Insurance