RN Member Triage

Arkansas Blue Cross and Blue Shield; Arkansas; Hybrid; USD 66,000 - 84,000; Full time

Benefits offered by this job

Tuition reimbursement

Club Blue onsite gym

Green Leaf Grill and Grill Express

Job summary

Arkansas Blue Cross and Blue Shield is seeking a remote Member Triage Nurse to assess members and route resources for CSPH. The role supports CSPH by answering calls, routing to customer service, and facilitating warm transfers to case management and other services.

You will promote communication across omni-channel platforms including mobile apps. Requirements include an active RN license, a preferred Bachelor's in Nursing, and at least four years of clinical nursing experience in

Qualifications

• Bachelor's degree in Nursing preferred.
• Registered Nurse (RN) license in good standing required.
• Minimum four years of clinical practice nursing experience.

Responsibilities

• Liaises with patients, families, physicians, discharge planners and home care providers to promote quality of care and cost effectiveness.
• Adheres to licensure scope, policies, URAC standards and state regulations; makes evidence-based decisions for appropriate care and patient safety.
• Maintains current knowledge of medical/surgical procedures, products, services and enterprise procedures and contracts.
• Manages chronic health condition gaps through health education and case management, promoting timely care and cost containment.
• Performs other duties as assigned.
• Coordinates referrals from multiple sources to identify care gaps and coordinate case management.

Skills

Active Listening

Written Communication

Time Management

Interpersonal Skills

Microsoft Excel

Microsoft Word

Outlook

Cross-functional Communications

Education

Bachelor's degree in Nursing

Tools

Microsoft Excel

Microsoft Word

Microsoft Outlook

Job description

To learn more about Arkansas Blue Cross and Blue Shield Hiring Policies, please click here.

Job Summary The member triage nurse assesses members for needed resources such as community resources, vendor assistance, case management services, and other interdisciplinary services associated with Clinical Services and Population Health division (CSPH). This position is responsible for answering and routing calls to support the CSPH division, including warm transfers to/from customer service, case management, other support services and resources as appropriate. This position is also responsible for promoting communication through any other omni channels available such as mobile applications.

Requirements

EDUCATION Bachelor's degree in Nursing preferred.

LICENSING/CERTIFICATION Registered Nurse (RN) with current active state license in good standing in the state(s) where job duties are performed required. Case Management certification preferred.

EXPERIENCE Minimum four (4) years' clinical practice nursing experience in at least one of the following areas: medical-surgical nursing, surgical nursing, intensive care or critical care nursing.

ESSENTIAL SKILLS & ABILITIES Excellent oral and written communication skills Detail-Oriented Proficiency using basic computer skills in Microsoft Office such as Word, Excel, and Outlook, including the ability to navigate multiple systems and keyboarding. Ability to prioritize and make sound nursing judgments through critical thinking. Ability to build collaborative relationships. Ability to interpret complex documentation. Ability to work independently with little supervision.

Location

This role is 100% remote. Preference will be given to current employees and candidates who reside in Arkansas.

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
• Microsoft Excel
• Microsoft Outlook
• Microsoft PowerPoint
• Microsoft Word
• Oral Communications
• Problem Sensitivity
• Public Relations (PR)
• Researching
• Service Oriented
• Support Coordination
• Time Management
• Written Communication

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.

Certifications

Registered Nurse (RN) - Arkansas State Board of Nursing Hiring Range $66,260.00 - $84,030.00

Security Requirements

This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual. Segregation of Duties Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.

Employment Type

Regular ADA Requirements 2.1 General Office Worker, Semi-Active, Campus Travel - Someone who normally works in an office setting or remotely, periodically has lifting and carrying requirements up to 40 lbs and routinely travels for work within walking distance of location of primary work assignment as essential functions of the job.

Why?

We Love our Employees At Arkansas Blue Cross, we care about the health, wellness, and education of our employees.

• Tuition reimbursement.
• Club Blue, a free, onsite gym to encourage exercise.
• Green Leaf Grill and Green Leaf Grill Express, onsite restaurants in Little Rock that promote healthy eating.
• Incentives for wellness education and exercise

We Love our Culture

The average tenure is 10 years with hundreds of employees having been here 15 years or longer. Our inclusive culture brings employees together to connect while celebrating our differences.

We Love our Community

Our employees often volunteer within their communities, at charity events, walks and runs, schools and nonprofits. When disasters strike, our employees help wherever they are needed. It’s just another way we show that Blue cares.