Population Health Onsite RN

Blue Cross and Blue Shield of Louisiana

7d • Onsite

About The Position

Provides on-site face-to-face care management services to members at specific client office building sites to comply with contractual obligations. Identifies employees with certain chronic health conditions, reviews medical treatment, claims, coordination of care, gaps in care and care needs to design and deliver care interventions designed to improve health and financial outcomes. Utilizes a collaborative, multi-disciplinary process to assess, plan, implement, monitor, and evaluate options and services required to meet the healthcare needs of individuals. Establishes personal relationships with employees, coaches members and promotes wellness activities designed to increase their personal health accountability and improve their overall health. Primarily serves as a health coach and refers clients to appropriate Blue Cross representatives to address specific issues and, determine possible solutions, including but not limited to customer service, claims, appeals and network. Accountable for complying with all laws, regulations and accreditation standards that are associated with duties and responsibilities.

This role does not manage people
This role reports to this job: MANAGER, POPULATION HEALTH
Necessary Contacts: In order to effectively fulfill this position the incumbent must be in contact with: Benefits Administration, Medical Director, Underwriting, Group leaders, Delegated Vendors, Legal Department and other employees as needed, physicians/staff, hospital administrators/staff, providers, caregivers, subscribers, community resources.

Requirements

• Diploma, Associate’s, Bachelor's or Master’s Degree in nursing
• 4 years of experience in a clinical care setting required.
• Active and unencumbered(current and unrestricted) RN license to practice in Louisiana is required.
• Requires the ability to work independently and anticipate needs to make decisions with minimal supervision, implement and evaluate appropriate healthcare services in conjunction with a physician treatment plan evaluating the effectiveness of alternate care services.
• Utilizing a variety of data resources, have the ability to research and analyze contracts/cases/populations and make appropriate quality and cost effective decisions is required.
• Also must demonstrate excellent interpersonal, organizational, analytical, and telephonic skills.
• Must demonstrate strong communication skills, including the ability to effectively explain/present claims information and procedures to persons with varied levels of insurance/benefits understanding.
• Requires working knowledge of related software and office equipment.
• The ability to comprehend, document, calculate, visualize, and analyze are required.

Nice To Haves

• Residency in or relocation to Louisiana is preferred for all positions.
• 2 years leadership experience preferred.
• Experience working in a stand-alone capacity at an offsite facility preferred.
• Experience in the use of behavioral interviewing techniques and theory is preferred.
• Multi-state Compact RN license is preferred.
• RN license in noncompact state is preferred.
• Certified Case Management Certification is preferred.

Responsibilities

• Assists with development of care pathways, onsite condition specific and wellness training programs, and evaluation of specific population needs in order to ensure continuous quality improvement (CQI).
• As needed, assesses and coaches others on behavioral interviewing and engagement techniques.
• Assess member’s status utilizing behavioral interviewing techniques, by collecting in-depth information in culturally competent and confidential manner, about the member’s situation and functioning to identify individual needs in order to develop and implement a comprehensive individualized care plan.
• The nurse will act as an advocate for the member/family, maintaining privacy, confidentiality, and safety, building relationships with all relevant parties.
• Complies with management requests for special projects and/or assignments of a non-routine nature.
• Develops formal recommendations and plans for process improvements and presents to supervisor and/or manager for consideration.
• Responsible for meeting annual targets for program performance as mutually agreed to by management team to maximize program value.
• Participates in quality improvement projects and data analysis to determine effectiveness of the program.
• Assists management with maintaining department timeliness standards and participating or acting as lead on cross-department projects.
• Interacts telephonically and face to face with patients in order to determine patient care needs, compliance and effectiveness with planned interventions, conduct case conferences as appropriate and connecting with appropriate provider and community resources.
• Utilizes appropriate professional nursing judgment in application of contractual benefits and limitations, administrative directives, and claims policy in order to direct the appropriate course of action throughout the continuum of care and refer to appropriate resources to verify benefits.
• Perform other job-related duties as assigned, within your scope of responsibilities.

Benefits

• We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities.

What This Job Offers

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