RN Care Manager: Onsite Lincoln Area Facility

Nebraska Blue; Lincoln (NE); Hybrid; USD 70,000 - 90,000; Full time

Job summary

Blue Cross and Blue Shield of Nebraska is seeking a RN Care Manager to work onsite in the Lincoln area. You will engage at-risk members to improve health and financial outcomes through analysis, planning and delivery of interventions.

The role requires an active RN license in Nebraska or a participating state, an Associate's degree, and at least 3 years of clinical nursing experience. Hybrid work model with occasional onsite commitments at Bryan Hospital East/West.

Qualifications

• Associate's degree in nursing and active RN license in Nebraska or participating state.
• At least 3 years of clinical nursing experience required.
• Experience with Medicare Advantage or managed care is a plus.

Responsibilities

• Screen and triage members for nurse advocacy and medical management programs.
• Conduct clinical assessments and engage members via multiple modalities.
• Act as a Nurse Care Manager to support self-management and care navigation.
• Collaborate with providers, utilization management, and care teams to ensure quality care.
• Educate members about benefits, coverage, and in-network resources.
• Maintain compliance with URAC and regulatory standards; participate in special projects.

Skills

Nursing

Case Management

Clinical Assessment

Customer Communication

Education

Associate's Degree in Nursing

Job description

RN Care Manager: Onsite Lincoln Area Facility page is loaded## RN Care Manager: Onsite Lincoln Area Facilityremote type: Hybridlocations: Work at Home - Nebraskatime type: Full timeposted on: Posted 3 Days Agojob requisition id: JR101440At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve.Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there's no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, you'll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.This position will engage at risk members to improve health and financial outcomes through analysis of needs, design, and delivery of interventions. The Nurse Care Manager educates members to understand innovative benefit structures that promote transparency and affordability and empowers consumers to make informed decisions regarding their healthcare options, coverage, and financial risk. This role supports members in developing self-management skills and adopting positive behavior changes, identifies and addresses barriers to member's adherence to standards of evidence-based medicine. Identifies resources to assist members in achieving their personal health goals, and proactively incorporates lifestyle improvement and prevention opportunities into member interventions. The Nurse Care Manager assists members in navigating the complex health care settings and ensures they get the support they need to optimize their overall health status.**Candidates applying to this position must live within driving distance of the Lincoln, Nebraska metro and required to be onsite at Bryan Hospital East and Bryan Hospital West.****What you'll do:*** Screen and triage members for levels and types of nurse advocacy and medical management programs, including but not limited to: member outreach initiatives, Case Management, and Nurse Health Coaching for chronic conditions.* Follow the nursing process of assessment, planning, implementation, and evaluation of member-centric goals and interventions for members enrolled in the case management program.* Conduct clinical assessments and engage members through a variety of approaches that will include telephonic and mobile application interventions depending on the model of care delivery. Clinical assessments address the health and wellness needs of BCBSNE members using a broad set of clinical and motivational interviewing skills with the goal of effecting members' self-management and positive behavior changes.* Function as a Nurse Care Manager for members with medical needs with the level of engagement ranging from coaching interventions to intensive case management interventions. Across the continuum of services, the goal is always to help develop and support the member's ability to self-manage and navigate the health care system and to provide members with resources and tools to assist in health-related decision making.* Collaborate and consult with healthcare providers, members, internal team of clinical support specialists, Utilization Management, physicians, medical directors and pharmacists to ensure medically appropriate, high quality, cost-effective care, promote positive member outcomes, effective use of resources, optimize member benefits, and support business initiatives; conducting prospective, concurrent and retrospective utilization reviews for medical necessity as needed.* Act as a resource within the department and to other departments regarding medical management issues and activities, including attending presentations and onsite group events.* Educate members about their benefits and coverage, and guide members to appropriate programs, community resources, and in-network providers.* Maintain compliance requirements by knowing, understanding, and adhering to URAC accreditation standards and other regulatory requirements.* Responsible for maintaining professional licensure and practicing within the scope of licensure.* Responsible for completion of special projects, examples may include training new hires, provider outreach, project work, peer mentor, new system implementation, and system testing.* **Hours: 8am-5pm Monday to Friday with some flexibility. This position doesn't have any on-call, weekend or holiday rotation.****To be considered for this position, you must have:*** Associate's Degree in Nursing* The Nurse Care Manager must hold an active, current, and unrestricted Registered Nurse license from the state of Nebraska or a state in the consortium in which Nebraska participates.* Three (3) years clinical nursing practice experience.**The strongest candidates for this position will also possess:*** Demonstrated previous experience working in Medicare Advantage and Managed Care organizations.* Bachelor's degree in healthcare field.* Certification in Case Management, Managed Care, and/or Health Coaching.* Clinical experience in multiple levels of care.* Experience in discharge planning, Health Coaching, case management, or disease management.* Knowledge of accreditation standards and regulatory requirements.* Medicaid and Medicare Care Management experience.Learn more about what makes BCBSNE such an exceptional place to work by visiting .*We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.*On the cutting edge of the health care industry, helping Nebraskans in moments of joy, times of hardship and the steps in between.We are Blue Cross and Blue Shield of Nebraska (BCBSNE), and we exist to be there for people when they need us. Our goal is to add more good, healthy years to people's lives by supporting our customers and the Nebraska community at large. We have more than 80 years of experience behind us. And a bright future ahead as we continuously innovate to drive health care forward while meeting the needs of our members and state.If you're passionate about helping people along their health journeys, we invite you to explore our career offerings.Here, you will find opportunities to grow personally and professionally while making a difference for our customers and greater Nebraska community.