RN Specialist Cmplx CM

About the position At reputed company, we are committed to paving the way for everyone to reputed company their healthiest life. We are looking for dedicated and motivated individuals who share our reputed company of transforming reputed company. As a reputed company associate, you are joining a culture that is built on values of succeeding together, finding a reputed company way, and doing the right thing. If you are reputed company to reputed company 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 reputed company, 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 reputed company case manager with managed care experience will be successful in this role.

Responsibilities

• Receives referral for member identified with high cost, reputed company medical conditions and telephonically outreaches to the member, family and providers to engage in reputed company 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 reputed company 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 reputed company points of customer contact.
• Understands the strategic and financial goals of the department, reputed company care management teams, and the reputed company
• 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 reputed company 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 reputed company treatment plans, care coordination, and transition of care between settings.
• Identifies and implements cost saving opportunities to ensure reputed company and cost-effective health outcomes.

Requirements

• Registered nurse with reputed company MN license and with no restrictions
• reputed company 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 reputed company 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.

reputed company-to-haves

• 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).

Benefits

• Medical, dental, and reputed company insurance
• Life insurance
• 401k
• Paid Time Off (PTO)
• Volunteer Paid Time Off (VPTO)

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