RN Member Triage

Arkansas Blue Cross Blue Shield

1d

About The Position

The member triage nurse assesses members for needed resources such as community resources, vendor assistance, case management services, and other interdisciplinary services associated with Clinical Services and Population Health division (CSPH). This position is responsible for answering and routing calls to support the CSPH division, including warm transfers to/from customer service, case management, other support services and resources as appropriate. This position is also responsible for promoting communication through any other omni channels available such as mobile applications.

Requirements

• Bachelor's degree in Nursing preferred.
• Registered Nurse (RN) with current active state license in good standing in the state(s) where job duties are performed required.
• Minimum four (4) years' clinical practice nursing experience in at least one of the following areas: medical-surgical nursing, surgical nursing, intensive care or critical care nursing.
• Excellent oral and written communication skills
• Detail-Oriented
• Proficiency using basic computer skills in Microsoft Office such as Word, Excel, and Outlook, including the ability to navigate multiple systems and keyboarding.
• Ability to prioritize and make sound nursing judgments through critical thinking.
• Ability to build collaborative relationships.
• Ability to interpret complex documentation.
• Ability to work independently with little supervision.

Nice To Haves

• Case Management certification preferred.

Responsibilities

• Communication: Serves as a liaison facilitating a collaborative process which includes patients, families/caregivers, physicians, hospital discharger planners, home care providers and other ancillary providers to promote quality of care, cost effectiveness, accessibility and appropriateness of service levels.
• Compliance: Practices nursing within the scope of licensure and adheres to policies, procedures, regulations, URAC standards and individual state regulations; making decisions based on facts and evidence to ensure compliance, appropriate level of care, and patient safety.
• Knowledge: Remains current with up-to-date medical and surgical procedures, products, healthcare services and drugs, general trends in health care delivery; and enterprise procedures, policies and contracts.
• Member Triage: Assesses and resolves gaps in patient care related to chronic health conditions through health education and case management services ensuring gaps are closed in a timely matter. Promotes appropriate care and quality toward cost effective and cost containment measures based on evidence.
• Performs other duties as assigned.
• Workflow: Works proactively with referrals from multiple sources to identify gaps in care candidates for case management, explaining services ensuring voluntary agreement of services and maintaining a minimum patient caseload in a timely matter.

Benefits

• Tuition reimbursement.
• Club Blue, a free, onsite gym to encourage exercise.
• Green Leaf Grill and Green Leaf Grill Express, onsite restaurants in Little Rock that promote healthy eating.
• Incentives for wellness education and exercise

What This Job Offers

• Job Type: Full-time