Telephonic Case Management Nurse – Medicare/Medicaid

Lablue; Monroe (LA); On-site; USD 68,000 - 90,000; Full time

Job summary

Blue Cross Blue Shield of Louisiana seeks a Case Management Nurse to deliver telephonic case management for Medicare and Medicaid members, coordinating care and guiding families toward appropriate resources in alignment with CMS standards and BCBSLA policies.

You will collaborate with the member, care providers, and a multi-disciplinary team to assess needs, create individualized care plans, and monitor progress to improve wellness outcomes.

Qualifications

• High School Diploma required.
• 4 years of general clinic experience is required.
• 1 year of clinical experience in case management, acute hospital discharge planning or utilization review is preferred.
• Previous direct clinical care to patients in a behavioral health setting is preferred.

Responsibilities

• Performs telephonic case management and care coordination activities, communicating with the multidisciplinary team.
• Reviews each case individually and evaluates for referral to Social Services, Behavioral Health, Disease Management, community resources and other resource needs.
• Collects pertinent clinical information using the Acuity case management system and documents findings.
• Evaluates the Health Risk Assessment for timely interventions to ensure provision of optimal care.
• Coordinates community care and services as deemed appropriate.
• Develops individualized care plans with the member and family through collaboration with the Interdisciplinary Care Team (ICT).
• Provides ongoing evaluation of progress and efficacy of services, adjusting plans as needed.
• Participates in quality improvement processes and serves as a liaison for patient advocacy.

Skills

Interpersonal communication

Documentation

Problem solving

Decision making

Accountability

Integrity

Customer focus

Collaboration

Education

High School Diploma

Tools

Acuity case management system

Job description

Blue Cross Blue Shield of Louisiana seeks a Case Management Nurse to deliver telephonic case management for Medicare and Medicaid members, coordinating care and guiding families toward appropriate resources in alignment with CMS standards and BCBSLA policies.

You will collaborate with the member, care providers, and a multi-disciplinary team to assess needs, create individualized care plans, and monitor progress to improve wellness outcomes.