FEP Care Coordinator

Blue Cross Blue Shield of Alabama; Birmingham (AL); Remote; USD 70,000 - 95,000; Full time

Benefits offered by this job

Remote work

Up to 10% travel

Job summary

Blue Cross Blue Shield of Alabama is seeking a Registered Nurse Case Manager for a full-time remote role. You will develop, coordinate, and administer member management programs, coordinating case activity and maximizing contract benefits through assessment and planning.

The ideal candidate has an RN license (multistate or Alabama), at least three years of clinical experience in relevant areas, and strong communication and autonomous decision-making abilities. Travel up to 10% may be required.

Qualifications

• Bachelor's degree or actively pursuing one.
• Active RN license in good standing.
• Multistate RN licensure or Alabama RN licensure; plan to obtain licenses in other states as applicable.
• Willingness to attain Case Management certification within 2 years of hire.
• Minimum of three years of clinical experience in medical/surgical, psychiatric, or obstetrical settings.
• Excellent verbal and written communication with providers, subscribers and group representatives.
• Ability to analyze clinical situations and make autonomous decisions.
• Experience communicating information to staff at all levels.

Responsibilities

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

Skills

Verbal and written communication

Independent decision-making

Clinical assessment and case mgmt

Negotiation skills

Travel up to 10%

Education

Bachelor's Degree or pursuing

Registered Nurse (RN) license

Multistate RN licensure or Alabama RN licensure

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)
• Multi-State licensure as a Registered Nurse allowing practice in the State of Alabama or a State of Alabama licensure as a Registered Nurse, and upon hire, agree to actively pursue a Registered Nurse licensure in other States as applicable
• Willingness to attain Case Management certification within 2 years of hire date
• 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 clinical situations 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
• Experience making informed decisions in an autonomous setting
• 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
• Knowledgeable of benefit guidelines, claims payment guidelines, billing guidelines, laws and contracts that govern the health insurance programs administered by Blue Cross and Blue Shield of Alabama preferred
• Experience in OR, ICU, Med Surg, or Dialysis specialties preferred
• Experience in Home Health and/or Case Management preferred

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

By submitting a job application, I attest that all information to the best of my knowledge is true and accurate. Furthermore, I understand that any information provided by me throughout the job application process is subject to verification including, but not limited to work experience, education, assessment (test) and interviews. 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.