Care Coordinator - Enhanced Case Management

Blue Cross Blue Shield of Alabama; Birmingham (AL); Remote; USD 70,000 - 90,000; Full time

Job summary

Blue Cross and Blue Shield of Alabama is seeking a Registered Nurse Case Manager for a full-time remote role. You will develop and coordinate member management activities, communicate with care providers, subscribers, and group representatives, and maximize benefits through case coordination and planning.

The role requires an Alabama RN license (or multi-state compact) and at least three years of clinical experience in relevant settings.

Qualifications

• Bachelor's Degree or pursuing it.
• Active RN license in good standing.
• Alabama RN licensure or Multi-State licensure (Compact).
• Minimum of three years of clinical experience in medical/surgical, psychiatric, or obstetrical settings.
• Excellent verbal and written communication with providers, subscribers, and groups.
• Experience in autonomous decision-making and independent work.

Responsibilities

• Develop, coordinate, and administer activities related to Member Management Programs.
• Communicate effectively with members and group representatives within the health care delivery system.
• Coordinate case activity and maximize contract benefits by evaluating needs and creating care plans.

Skills

Verbal communication

Written communication

Independent decision-making

Autonomous work

Travel up to 10%

Education

Bachelor's degree (or pursuing)

RN license (AL or multi-state)

Job description

Overview

The Health and Clinical Engagement division provides valuable health and wellness services to help people maximize their health and quality of life. Health Management is one of the most critical issues Blue Cross and Blue Shield of Alabama faces in fulfilling its responsibility to be a superior administrator of health care benefits. Our goal is to provide the highest quality benefits and services while we effectively control health care costs.

Department Overview

The Health and Clinical Engagement division provides valuable health and wellness services to help people maximize their health and quality of life. Health Management is one of the most critical issues Blue Cross and Blue Shield of Alabama faces in fulfilling its responsibility to be a superior administrator of health care benefits. Our goal is to provide the highest quality benefits and services while we effectively control health care costs.

Primary Responsibilities

This position is accountable for developing, coordinating, and administering all activities related to Member Management Programs. Activities involve effective communication with all members of the health care delivery system and group representatives. Individual member assessment and coordination of case management activities are additional responsibilities. The incumbent coordinates case activity and maximizes the member's contract benefits by evaluating the member's needs and developing alternative plans of treatment to provide quality care.

Summary of Qualifications

• Bachelor's Degree or upon hire commit to actively pursue a degree
• Active License in good standing as a Registered Nurse (RN)
• State of Alabama licensure as a Registered Nurse OR Multi-State licensure as a Registered Nurse (Compact)
• Minimum of three years of clinical experience in medical/surgical health care fields, a psychiatric, and/or an obstetrical setting
• Effective verbal and written communication skills with providers, subscribers and group representatives
• Experience analyzing and making informed decisions in an autonomous setting
• Experience in a position interpreting and communicating information orally and written with all levels of staff internal and external
• Experience in a position requiring independent decision-making skills
• Willingness to work a flexible schedule in order to provide telephone coverage
• Willingness to travel up to 10% of the time as needed
• Experience in a position using negotiation skills preferred
• Experience in a position presenting information in formal and informal settings preferred
• Certified Case Manager preferred
• Experience caring for patients with complex conditions such as COPD, diabetes, oncology, etc. preferred
• Experience with complex case management preferred
• Experience preferred in specialties such as: ICU, CCU, CVICU or Oncology

Work Location

The work schedule for this position will be full-time remote. Business areas reserve the right to require associates to return to the office as needed, based on performance or other business considerations. A remote work schedule is subject to amendment or termination at any time by the Company.

Terms and Agreements

We appreciate your interest in Blue Cross and Blue Shield of Alabama 'The Company'. The Company does not discriminate in hiring or employment on the basis of race, color, religion, creed, sex, sexual orientation, gender identity, national origin, age, disability, genetics, status as a disabled or protected veteran, or because of citizenship status in the case of a citizen or intending citizen. No question on this application is intended to secure information to be used for such discrimination. Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross and Blue Shield Association