Registered Nurse - Case Manager - RN

Job Description:Summary: This position is responsible for serving our customers by collaborating (with members, providers, employers, and internal customers) and coordinating benefits and health care services across the continuum of care, focusing on quality, cost-effective care for members with a variety of health care needs. The goals of this position are to:Maximize health and functional outcomesEducate members/care givers about their conditionSupport and encourage individual accountability for health and wellness (self-care management)Help members/families coordinate their needs and navigate services in the health care systemPromote the appropriate use of health care services/community resourcesImprove member satisfaction with the health plan and health care systemAccountabilities: - Identification of individuals with high cost, complex care that may benefit from case management services.- Gather relevant data required for the case management functions; case management, benefit management and/or member management. The focus is on obtaining accurate and comprehensive first hand information.- Collaborate and communicate with the health care team (member, family, or designated representative and the practitioner or other health care providers) on a plan of care that is acceptable to the health care team and employer group/others if indicated.- Develop an individual case management plan that is fiscally responsible and enhances quality, access and cost outcomes.- Evaluate and implement modifications to the case management plan.- Implement a continuity/transition of care plan for new members moving onto the health plan special needs, members whose primary and/or specialty provider has terminated their contract with Blue Cross Blue Shield of Minnesota (BCBSM) or members who have exhausted a contract benefit.- Complete case documentation according to standards.- Participate in discharge and care planning conferences as needed, coordinating plans and facilitating transition between sites of care.- Identify community resources and make appropriate referrals.- Serve as a resource to account managers and business units, and other customers in managing unique or complex cases.- Educate providers and members/enrollees on the benefits of case management, use of the health care delivery system, and optimal disease or condition management.- Actively participate as a member of a team by being engaged and demonstrating a positive attitude and providing back up to team members.- Support the case management quality improvement initiatives, process improvement and regulatory standards.- Accept responsibility for and complete special projects or reports as assigned.Required Qualifications: Registered nurse with current MN license.Minimum of 3 years of relevant clinical experience required.Preferred Qualifications: Managed care experience preferred.|Years of Experience Required: 3-5 YearsExpected Travel Time: None Company: Blue Cross Blue Shield of Minnesota Location: Saint Paul, MN 55120 Status: Full Time, Employee Job Category: Medical/Health