Case Management Nurse

Blue Cross and Blue Shield of Louisiana•Monroe, LA

About The Position

The Case Management Nurse supports members who have Medicare and are also entitled to Medicaid. The role conducts case management, care coordination, and quality activities in accordance with CMS standards and Blue Cross Blue Shield policies and procedures. Through telephonic assessments, the nurse evaluates member needs and requirements to help members achieve or maintain optimal wellness. The nurse identifies resource needs and guides members and their families toward appropriate care and wellbeing resources. The nurse collaborates with members, their care providers, and a multidisciplinary team to address members’ physical, environmental, and psychosocial health issues. This position does not manage people and reports to Departmental Leadership. The work is performed in a normal, clean office environment with normal noise levels; work is predominantly performed while standing or sitting. Residency in or relocation to Louisiana is preferred. Applicants must be authorized to work in the United States for Louisiana Blue without employer-sponsored immigration support. The company is an equal opportunity employer, maintains smoke- and tobacco-free properties, and conducts background checks and pre-employment drug screening after an offer and before hire.

Requirements

High school diploma.
Four years of general clinic experience.
Currently licensed to practice in Louisiana as a Licensed Practical Nurse (LPN), with graduation from an accredited vocational or technical school for Practical Nursing; the posting states 180 days required.
Current Compact License or ability to obtain a Compact License within 90 days of hire.
Exceptional interpersonal, verbal, and written communication skills.
Ability to document clearly and concisely.
Strong problem-solving skills.
Ability to work with limited supervision and make decisions based on established policies and procedures.
Ability to comprehend, document, calculate, visualize, and analyze.
Understanding of, or ability to become knowledgeable about, quality monitoring and improvement activities.
Applicants must be authorized to work for Louisiana Blue in the United States without employer-sponsored immigration sponsorship or other immigration support.

Nice To Haves

Residency in or relocation to Louisiana is preferred.
One year of clinical experience in case management, acute hospital discharge planning, or utilization review.
Previous direct clinical care experience in a behavioral health setting.

Responsibilities

Follow the Dual Plus Plan Model of Care goals, objectives, policies, and procedures to meet members’ individualized healthcare needs.
Participate in enrollment activities.
Perform telephonic case management and care coordination in communication with the multidisciplinary team.
Review cases and evaluate whether members should be referred to Social Services, Behavioral Health, Disease Management, community resources, or other resources.
Collect pertinent clinical information, including claims data when available, and document findings in the Acuity case management system.
Complete Health Risk Assessments covering physical, psychological, emotional, and environmental needs to support timely and appropriate interventions.
Coordinate community care and services as appropriate.
Develop individualized care plans with members and/or their families in collaboration with the Interdisciplinary Care Team (ICT).
Continuously evaluate member progress, care plan effectiveness, and the efficacy and appropriateness of services.
Consult and collaborate with relevant departments on care appropriateness, evidence-based clinical guidelines, medications, treatment plans, individualized care plans, and resource needs.
Participate actively as a member of the ICT, including attending ICT meetings.
Participate in quality improvement processes.
Serve as a liaison and patient advocate when applicable or requested by the patient or the patient’s legally appointed representative.
Perform other job-related duties within the scope of responsibilities as assigned.