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RN Specialist Complex Case Manager

Blue Cross and Blue Shield of Minnesota

Eagan, MN(remote)

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JOB DETAILS
SALARY
$79,100–$104,800 Per Year
SKILLS
Analysis Skills, Auditing, Business Skills, Case Management, Certified Case Manager (CCM), Clinical Assessment, Clinical Medicine, Clinical Outcomes, Clinical Research, Coaching, Communication Skills, Compensation and Benefits, Computer Skills, Cost Control, Emergency Care, Establish Priorities, Financial Strategy, Health Insurance, Health Plan, Healthcare, Healthcare Providers, Healthcare Reimbursement, High School Diploma, Insurance, Legal, Managed Care, Medical Conditions, Network Programming, Operations Planning, Organizational Skills, Physical Demands, Problem Solving Skills, Registered Nurse (RN), Relationship Management, Research Skills, Sales Management, State Laws and Regulations, Treatment Plan, Utilization Management
LOCATION
Eagan, MN
POSTED
2 days ago
### Job Duties 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 Manager 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). 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. 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. 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. Physical Requirements Apply Here: https://www.click2apply.net/GlGll2I4LyEGPfry2FXBX4 PI285479122 ### Minimum Education Required - ### Minimum Experience Required 5 years ### Shift First (Day) ### Number of Openings 1 ### Compensation $79,100.00 - $130,500.00 / Annually ### Postal Code 55121 ### Job Type Full Time ### Place of Work On-site ### Requisition ID 24796 ### Job Benefits Health Insurance

About the Company

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Blue Cross and Blue Shield of Minnesota