RN Member Triage

Arkansas Blue Cross Blue Shield; United States; Remote; USD 75,000 - 105,000; Full time

Job summary

Arkansas Blue Cross and Blue Shield is seeking a member triage nurse for a 100% remote role in the United States. The RN will assess resources, route calls, and support CSPH services, including omni-channel communication via mobile apps.

Education includes a nursing degree with RN licensure, and 4+ years clinical experience is preferred. The role emphasizes collaboration, strong communication, and case management support across multiple departments while maintaining patient safety and service

Qualifications

• Bachelor’s degree in Nursing preferred.
• Registered Nurse license in good standing in the state(s) where duties are performed required.
• Minimum four (4) years’ clinical practice nursing experience in medical-surgical, surgical, ICU or critical care.
• Excellent oral and written communication skills; strong detail orientation and critical thinking.

Responsibilities

• Communication: acts as a liaison to collaborate with patients, families, physicians, discharge planners and home care providers to ensure quality care and appropriate service levels.
• Compliance: practices nursing within licensure scope, follows policies, regulations, and contracts to ensure patient safety and appropriate care.
• Knowledge: stays current with medical and surgical procedures, products, services and enterprise policies.
• Member Triage: assesses and resolves gaps in patient care related to chronic conditions via health education and case management.
• Performs other duties as assigned.
• Workflow: coordinates referrals to identify care gaps and manage caseload timely.

Skills

Active Listening

Oral Communications

Written Communication

Critical Thinking

Problem Sensitivity

Time Management

Analytical Decision Making

Interpersonal Relationship Management

Education

Bachelor’s degree in Nursing

Tools

Microsoft Excel

Microsoft Outlook

Microsoft PowerPoint

Microsoft Word

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

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.