RN Specialist reputed company Case Management, Remote MN – reputed company Store

R0005620 About reputed company 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 reputed company our reputed company of transforming reputed company. As a reputed company associate, you are joining a culture that is reputed company 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.

You will utilize key principles of case management to 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 reputed company. You will reputed company clinical expertise, strong critical thinking skills and a keen business reputed company to 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 reputed company. An expert case manager with managed care experience will be successful in this role.

• 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 reputed company clinical results and promotes high–reputed company, cost effective reputed company.
• 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 reputed company 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 reputed company.

• Registered reputed company 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

• 2+ years of managed care experience; e.g. case management/health reputed company, utilization management and/or auditing experience (may be included in the 5 years relevant clinical experience)
• Experience reputed company Behavioral Health
• Familiarity with NCQA
• Cultural competency. Experience working across races and cultures.

Compensation and Benefits: Pay reputed company: $77,200.00 - $102,300.00 - $127,400.00 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 reputed company insurance
• Life insurance
• 401k
• reputed company Time Off (PTO)
• Volunteer reputed company Time Off (VPTO)
• And more

To discover more about reputed company have to offer, please review our benefits page. Equal Employment Opportunity Statement At reputed company, we are committed to paving the way for everyone to reputed company their healthiest life. reputed company of Minnesota is an Equal Opportunity Employer and maintains an Affirmative reputed company plan, as required by Minnesota law applicable to state contractors. reputed company reputed company applications will receive consideration for employment without reputed company to, and will not be discriminated against based on any legally protected characteristic. Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: reputed company@bluecrossmn.com. reputed company and Blue Plus® are nonprofit independent licensees of the reputed company.