[Hiring] Population Health RN @Blue Cross and Blue Shield of Louisiana

Role Description

Responsible for organizing, coordinating, and providing care coordination and case management services to members who are most at risk for health deterioration, sentinel events, and/or poor outcomes. Manage acute and chronically ill members to improve health and financial outcomes through analysis of needs, design, and delivery of interventions. Utilize a collaborative process to assess, plan, implement, monitor, and evaluate options and services required to meet the member’s healthcare needs. Through communication, the nurse will identify available resources to promote quality, cost effective outcomes. Accountable for complying with all laws, regulations and accreditation standards that are associated with duties and responsibilities.

Qualifications

• Education: Diploma in nursing or Associate’s in nursing or Bachelor's in nursing required.
• Work Experience:
  • 3 years of recent direct patient care/clinical experience is required.
  • 2 years of experience in managed care is preferred.
  • Experience in the use of behavioral interviewing techniques and theory is preferred.
• Skills and Abilities:
  • Ability to prioritize, work independently and anticipate needs to make decisions.
  • Ability to plan, implement and evaluate appropriate healthcare services in conjunction with a physician treatment plan.
  • Ability to research and analyze contracts/cases and make appropriate quality and cost effective decisions.
  • Knowledge of standardized code sets and medical terminology is required.
  • Excellent interpersonal, organizational, analytical, and telephonic skills.
  • Strong communication skills, including the ability to effectively explain/present claims information and procedures to persons with varied levels of insurance/benefits understanding.
  • Working knowledge of related software and office equipment.
• Licenses and Certifications:
  • Active and unencumbered (current and unrestricted) RN license to practice in Louisiana is required.
  • Multi-state Compact RN license is preferred.
  • Multi-state Compact RN license is required within 6 months from date of hire.
  • RN license in noncompact state is preferred.
  • May be required to obtain additional RN licensure in noncompact state within 6 months from date of hire.
  • Certified Case Management Certification is preferred.
  • Certified Case Management Certification is required within 3 years from date of hire.

Requirements

• Assess member’s status by collecting in-depth information about the member’s situation and functioning to identify individual needs.
• Develop and implement a comprehensive case management plan with specific objectives, goals, and actions.
• Act as an advocate for the member/family, maintaining privacy, confidentiality, and safety.
• Implement specific case management activities and/or interventions and evaluate effectiveness.
• Coordinate with members/families, providers, third party payors, employers, and community resources.
• Interact with patients and/or providers to determine patient care needs and compliance.
• Evaluate the case management plan’s effectiveness in reaching desired outcomes and goals.
• Utilize behavioral interviewing techniques.
• Familiar with guidelines and requirements for authorizations of services related to coordination of care for complex cases.
• Responsible for meeting individual quality performance standards and annual targets for program performance.
• Participate in Quality Improvement projects and data collection.
• May direct other staff in coordinating care.
• Perform other job-related duties as assigned, within your scope of responsibilities.

Benefits

• Resources to live well and be healthy.
• Opportunities for continuous learning and professional growth.
• Support for serving local communities.