Remote RN Triage & Care Navigator

Arkansas Blue Cross and Blue Shield; Little Rock (AR); Remote; USD 66,000 - 84,000; Full time

Job summary

Arkansas Blue Cross and Blue Shield is seeking a remote member triage nurse to assess resources, answer and route CSPH division calls, and promote omni-channel communication including mobile apps. The role emphasizes nursing judgment, collaboration, and timely care coordination.

Required RN license in good standing and strong communication skills. Experience in medical-surgical or critical care preferred; Bachelor's in Nursing is preferred. Remote work with Arkansas preference.

Qualifications

• RN license in good standing with the applicable state.
• Bachelor's degree in Nursing 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.

Skills

Active Listening

Analytical Decision Making

Business Compliance

Collaborative Communications

Conflict Resolution Management

Coordinating Resources

Critical Thinking

Cross-Functional Communications

Cross-Functional Planning

Data Management

Document Recording

Information Interpretation

Interpersonal Relationship Management

Oral Communications

Problem Sensitivity

Public Relations (PR)

Researching

Service Oriented

Support Coordination

Time Management

Written Communication

Education

Bachelor's degree in Nursing

Tools

Microsoft Excel

Microsoft Outlook

Microsoft Word

Microsoft PowerPoint

Job description

Arkansas Blue Cross and Blue Shield is seeking a remote member triage nurse to assess resources, answer and route CSPH division calls, and promote omni-channel communication including mobile apps. The role emphasizes nursing judgment, collaboration, and timely care coordination.

Required RN license in good standing and strong communication skills. Experience in medical-surgical or critical care preferred; Bachelor's in Nursing is preferred. Remote work with Arkansas preference.