RN Member Triage

Arkansas Blue Cross Blue Shield; Arkansas; À distance; USD 66 000 - 84 000; Plein temps

Résumé du poste

Arkansas Blue Cross Blue Shield is seeking a registered nurse to join our Clinical Services and Population Health (CSPH) team as a member triage nurse. The role focuses on assessing members for resources, coordinating care, and routing calls across omni-channel support, including mobile apps, to promote quality and cost-effective care.

The ideal candidate holds an active RN license in Arkansas, a Bachelor's degree in Nursing preferred, and at least four years of clinical experience in

Qualifications

• Bachelor's degree in Nursing preferred.
• RN license with active state license required.
• Case Management certification preferred.
• Minimum four (4) years' clinical practice nursing experience in medical-surgical, surgical, ICU or critical care nursing.

Responsabilités

• Communication: liaison among patients, families, physicians, discharge planners and home care providers to promote quality of care and cost effectiveness.
• Compliance: practice nursing within licensure scope and adhere to policies, procedures, URAC standards and state regulations.
• Knowledge: stay current with medical procedures, healthcare services and contracts.
• Member Triage: assess and resolve gaps in patient care related to chronic conditions through health education and case management.
• Performs other duties as assigned.
• Workflow: coordinate referrals to identify gaps in care and maintain caseload in a timely manner.

Connaissances

Oral communication

Written communication

Detail-oriented

Microsoft Office

Critical thinking

Collaboration

Documentation interpretation

Independent work

Formation

Bachelor's degree in Nursing

Outils

Microsoft Office

Description du poste

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.