[Hiring] RN Member Triage @Arkansas Blue Cross Blue Shield

Role Description

The member triage nurse assesses members for needed resources such as community resources, vendor assistance, case management services, and other interdisciplinary services associated with Clinical Services and Population Health division (CSPH). This position is responsible for:

• Answering and routing calls to support the CSPH division, including warm transfers to/from customer service, case management, and other support services.
• Promoting communication through various omni channels available, such as mobile applications.

Qualifications

• Bachelor's degree in Nursing preferred.
• Registered Nurse (RN) with current active state license in good standing in the state(s) where job duties are performed required.
• Case Management certification preferred.
• Minimum four (4) years' clinical practice nursing experience in at least one of the following areas: medical-surgical nursing, surgical nursing, intensive care, or critical care nursing.

Requirements

• Excellent oral and written communication skills.
• Detail-Oriented.
• Proficiency using basic computer skills in Microsoft Office such as Word, Excel, and Outlook.
• Ability to prioritize and make sound nursing judgments through critical thinking.
• Ability to build collaborative relationships.
• Ability to interpret complex documentation.
• Ability to work independently with little supervision.
• This role is 100% remote. Preference will be given to current employees and candidates who reside in Arkansas.

Skills

• Active Listening
• Analytical Decision Making
• Business Compliance
• Collaborative Communications
• Conflict Resolution Management
• Coordinating Resources
• Critical Thinking
• Cross-Functional Communications
• Cross-Functional Planning
• Data Management
• Document Recording
• Information Interpretation
• Interpersonal Relationship Management
• Microsoft Excel
• Microsoft Outlook
• Microsoft PowerPoint
• Microsoft Word
• Oral Communications
• Problem Sensitivity
• Public Relations (PR)
• Researching
• Service Oriented
• Support Coordination
• Time Management
• Written Communication

Responsibilities

• Communication: Serves as a liaison facilitating a collaborative process which includes patients, families/caregivers, physicians, hospital discharger planners, home care providers, and other ancillary providers to promote quality of care, cost effectiveness, accessibility, and appropriateness of service levels.
• Compliance: Practices nursing within the scope of licensure and adheres to policies, procedures, regulations, URAC standards, and individual state regulations; making decisions based on facts and evidence to ensure compliance, appropriate level of care, and patient safety.
• Knowledge: Remains current with up-to-date medical and surgical procedures, products, healthcare services and drugs, general trends in health care delivery; and enterprise procedures, policies, and contracts.
• Member Triage: Assesses and resolves gaps in patient care related to chronic health conditions through health education and case management services ensuring gaps are closed in a timely manner.
• Performs other duties as assigned.
• Workflow: Works proactively with referrals from multiple sources to identify gaps in care candidates for case management, explaining services ensuring voluntary agreement of services and maintaining a minimum patient caseload in a timely manner.

Certifications

• Registered Nurse (RN) - Arkansas State Board of Nursing

Employment Type

• Regular

ADA Requirements

• General Office Worker, Semi-Active, Campus Travel - Someone who normally works in an office setting or remotely, periodically has lifting and carrying requirements up to 40 lbs and routinely travels for work within walking distance of the location of primary work assignment as essential functions of the job.