Care Guide, RN

Blue Cross Blue Shield of Kansas City • Kansas City, MO

13d • Hybrid

About The Position

Spira Care was designed with our patients at the center of their Care Teams. This collaborative, patient-centered approach to primary care offers patients a one-of-a-kind healthcare experience and offers healthcare professionals an opportunity to really see the impact they can make in their patients’ lives. Our Care Teams are made up of professionals with diverse backgrounds, experiences, and focus areas who are curious, empathetic, and collaborative. Spira Care is looking to welcome people on our team who are excited about innovating in primary care and are passionate about helping people achieve their health goals. The Care Guide, RN is an integral role within the Care Team who will fulfill key member-experience responsibilities by managing member interactions at Spira Care and assisting members with navigating through the complexities of healthcare to make the experience simple, personal and transparent. They will effectively leverage a myriad of skill sets to provide the member a seamless healthcare experience, blending administrative, educational and care coordination functions. Care Guide RNs will work with members primarily in face to face settings but also on the phone; creating connections and care along the way.

Requirements

• Associate or bachelor’s degree in nursing
• Valid and active Registered Nurse (RN) in Kansas and Missouri or multi-state compact license
• BLS certification from American Red Cross or American Heart Association. Maintain licensures and certifications throughout employment.
• 5 years of healthcare experience
• 3 years of full-time direct patient care and clinical experience in medical/surgical, pediatrics or obstetrics
• Intermediate level knowledge of Clinical Guidelines required
• Previous experience in customer service or serving customers in some direct capacity.
• Phone experience preferable but not required
• Advanced keyboarding knowledge
• Intermediate knowledge of Microsoft applications including Word, Excel, PowerPoint and OneNote
• Must be able to comply with Spira Care's specific vaccination requirements as a condition of employment, with or without reasonable accommodation based on a sincerely held religious belief or a disability.

Nice To Haves

• Bachelor’s degree in nursing
• Case Management Certification
• 5 years' experience, including at least three years of Care/Case/Disease Management, Health Plan, or Utilization Review experience
• Thorough understanding of advanced primary care and the Patient Centered Medical Home (PCMH) / Primary Care First (PCF) model
• Understanding of Affordable Care Act and Medicare/CMS
• Thorough knowledge of URAC and NCQA guidelines and state and federal regulations
• Experience working with Health and Wellness programs or an understanding of wellness principles
• Intermediate level knowledge of athena EMR application
• Intermediate level knowledge of FACETS UM, CM and claims applications
• Intermediate level knowledge of GuidingCare application

Responsibilities

• Establishes a trusted partnership with the Patient in both face-to-face and phone settings, building credibility through knowledge sharing and collaboration around healthcare needs.
• Completes Patient assessments by collecting and analyzing information and developing and implementing individualized care plans with appropriate interventions in a culturally sensitive way. Completes these assessments in the areas of clinical, functional, financial, support system, psychosocial, cognitive and environmental realms.
• In collaboration with the Care Team, monitors effectiveness of the care plan by gathering sufficient information from relevant sources to intervene, as appropriate, to improve health outcomes.
• Determines appropriate intervals for monitoring care plans.
• Utilizes internal, community and other healthcare resources to maximize outcomes.
• Provides a high degree of customer service in both face-to-face and phone interactions with Patients, providers and community organizations.
• Acts as liaison between Patients, employers, providers, support systems and Blue Cross Blue Shield of Kansas City.
• Works with multiple members of the healthcare team to foster continuity and coordination of care.
• Utilizes all forms of communication effectively to maximize a collaborative relationship (including incoming/outgoing phone calls, in-person consultation, written communications such as email, web-based messaging and other relevant communication channels).
• Manages projects and competing priorities and deadlines to ensure Patients and relevant entities receive information in a timely manner.
• Builds relationships within their own Care Center and works across other Care Centers to share best practices and foster innovation.
• Acts as a critical “Care Team” member and works closely with the providers and staff to support the Patient.
• Prioritizes interventions based on Patients’ clinical and social needs and readiness to change.
• Educates and works with Patients at different educational and health literacy levels in a culturally sensitive manner.
• Utilizes clinical knowledge and critical thinking skills to individualize plans of care.
• Assesses Patients’ need for education and tailors teaching to their knowledge level and learning style.
• Maintains confidentiality of all regulated information in compliance with state and federal laws.
• Reads, understands and follows medical policy and all corporate, divisional and departmental policies and procedures (including but not limited to: Protected Health Information (PHI) and Personal Identifiable Identification (PII) and Heath Insurance Portability and Accountability Act (HIPAA)).
• Meets individual, team and company quality performance standards and annual targets for program performance as mutually agreed to by leadership to maximize program value; ensures compliance with applicable URAC and NCQA accreditation guidelines and state and federal regulations
• Schedules time effectively.
• Works with minimal supervision; handles multiple projects simultaneously.
• Prioritizes work appropriately
• Presents information and responds to questions from groups of managers, providers, coworkers and Patients
• Defines problems (technical and clinical), collects data, establishes facts and draws valid conclusions and action plans
• Works with a variety of tools/applications used to access and document health and insurance information and support Patient interactions of various communication channels (phone, in-person, chat, email, etc.)
• May be required to travel between Care Centers

Benefits

• Highly competitive total rewards package, including comprehensive medical, dental and vision benefits
• 401(k) plan that both the employee and employer contribute
• Annual incentive bonus plan based on company achievement of goals
• Time away from work including paid holidays, paid time off and volunteer time off
• Professional development courses, mentorship opportunities, and tuition reimbursement program
• Paid parental leave and adoption leave with adoption financial assistance
• Employee discount program

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree