ABOUT BLUE CROSS AND BLUE SHIELD OF MINNESOTA

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us.

REQUIRED SKILLS AND EXPERIENCES

• Registered Nurse license with no restrictions.
• 3 years relevant direct clinical care experience.
• All relevant experience including work, education, transferable skills, and military experience will be considered.
• CCM Certification or ability to obtain within 3 years of starting in the position.
• Excellent communication skills.
• Excellent conceptual thinking skills.
• Excellent relationship management skills.
• Excellent organizational skills.
• Computer application proficiency.
• Flexibility to work varied hours.
• High school diploma (or equivalency) and legal authorization to work in the U.S.

PREFERRED SKILLS AND EXPERIENCES

• 1+ years of managed care experience; e.g.case management/health coach, utilization management and/or auditing experience.
• Outstanding telephonic skills.

• Receives referral and/or reaches–out to member and leverages clinical knowledge, motivational interviewing and behavioral modification techniques.
• Conducts comprehensive clinical assessments; gathers, analyzes, synthesizes and prioritizes member needs and opportunities.
• Collaborates and communicates with member, family, or designated representative on a plan of care that produces positive clinical results and promotes high-quality effective outcomes.
• Identifies relevant BCBSMN and community resources and facilitates warm program and network referrals.
• Monitors and evaluates plan of care over time.
• Ensures member data is documented according to BCBSMN application protocol and regulatory standards.
• Maintains outstanding level of service at all points of customer contact.
• Understands broad–based goals of assigned market segment(s) including clinical and service availability.
• Collaborates and coordinates with team members to facilitate day to day functions and enhance the overall operation of the department.
• Engage providers telephonically in reviewing and understanding treatment plans, including alignment with benefits and medical reimbursement policies to facilitate optimal treatment plans, care coordination, and transition of care between settings.