FEP Care Coordinator

Blue Cross and Blue Shield of Alabama; Birmingham (AL); Remote; USD 65,000 - 90,000; Full time

Job summary

Blue Cross and Blue Shield of Alabama seeks a Registered Nurse to lead member management programs. You will coordinate case activities, assess member needs, and craft alternative treatment plans to maximize contract benefits.

The role emphasizes clear communication with providers, subscribers, and groups. Requirements include an active RN license, Alabama or multi-state licensure, and a willingness to obtain Case Management certification within two years.

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 Alabama or Alabama licensure, and upon hire, agree to pursue 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 interpreting and communicating information orally and in writing 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 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 governing health insurance programs.
• Experience in OR, ICU, Med Surg, or Dialysis specialties preferred.
• Experience in Home Health and/or Case Management preferred.

Responsibilities

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

Skills

RN license

Case management

Communication skills

Independent decision-making

Travel readiness

Education

Bachelor’s Degree or pursuing degree

Job description

Overview 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