RN Specialist Complex Case Management – Transplant at Blue Cross Blue Shield of Minnesota

About Blue Cross and Blue Shield of MinnesotaAt 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 HaveThis role will have primary responsibility for TransplantManagement!Utilizing key principles of case management the RN Specialist will research and analyze the members 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 tooptimal cost-effective outcomes. Leveraging clinicalexpertise 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 departmentutilizationoptimizesite 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.This position focuseson members going through the transplant experience. This clinician receives referrals andleveragesclinical and condition pathway knowledge for outreach stratification.Your ResponsibilitiesReceivesreferralformemberidentified withhigh cost complex medical conditions and telephonically outreaches to the memberfamilyand providers to engage in complex case managementprogram.Conducts clinical assessments with members and providersutilizingmotivational interviewing; gathers analyzessynthesizesand 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 promoteshighquality cost effective outcomes.Identifiesrelevant BCBSMN and community resources andfacilitatesprogram 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 enterpriseKnowledgeable of health plan operations (e.g.networks eligibility benefits)Promotes innovative solutions to improveday to dayfunctions and enhance the overall operation of the department.Collaborates with interdisciplinary care team to develop a comprehensive plan of care toidentifykey strategic interventions to addressmembersneeds and health care cost drivers.Engage providerstelephonically in reviewingandunderstandingtreatment plans including alignment with benefits and medical reimbursement policies tofacilitateoptimaltreatment plans care coordination and transition of care between settings.Identifiesand implementscost savingopportunities to ensureoptimaland cost-effective health outcomes.Required Skills and ExperienceRegistered nurse with current MN license and with no restrictionsAll relevant experience including work education transferable skills and military experience will be considered.5 years relevant clinical care experienceCCM Certificate or ability to obtain within 3 years of starting in the positionExcellent telephonic skillsKeen business skillsExcellent communication skillsExcellent conceptual thinking skillsExcellent relationship management skillsExcellent organizational skillsComputer applicationproficiencyStrong resiliency and flexibility skillsExcellent research analytical and creative problem-solving skillsFlexibility to work varied hoursHigh school diploma (or equivalency) and legal authorization to work in the U.S.Preferred Skills and Experience2 years of managed care experience;e.g.case management/health coachutilizationmanagementand/or auditing experience (may be included in the 5 years relevant clinical experience).3 years relevant clinical care experience including transplantRole DesignationTeleworkerRole designation definition: Teleworking is working full time remote. Hybrid is a minimum of 2 days onsite. Onsite is full-time onsite.Compensation and Benefits$77200.00 - $102300.00 - $127400.00 AnnualPay 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 insuranceLife insurance401kPaid Time Off (PTO)Volunteer Paid Time Off (VPTO)And moreTo discover more about what we have to offer please review our benefits page.Equal Employment Opportunity StatementAt 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.Individuals with a disability who need a reasonable accommodation in order to apply please contact us at: Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.Required Experience:IC Key Skills General Insurance,Corporate Sales,Cost Estimation,Benefits & Compensation,Heavy Equipment,AC Maintenance Employment Type : Full-Time Experience: years Vacancy: 1 Yearly Salary Salary: 77200 - 127400