G

GuideWell Mutual

Nonprofit mutual health insurance group in Florida

Registered Nurse - Florida Blue Center

Nursing & Frontline Patient CareConfirmed live in the last 24 hours
Full-timeTallahassee, FL, USA

About the Job

Requirements

  • At least 1 year of related work experience in nursing.
  • A high school diploma or GED.
  • An active Florida registered nurse license or compact state licensure upon hire; an active Florida registered nurse license is specified.
  • Basic Life Support CPR certification upon hire.
  • Health Coaching Certification within 180 days or 6 months after hire, maintained as current during employment.
  • Knowledge and understanding of benefit plans and the healthcare continuum.
  • Experience with automated medical systems.

Responsibilities

  • Provide personal care engagement and assistance coordinating healthcare benefits and services to prospective customers and members in the Direct-to-Consumer Channel.
  • Perform Personal Health Assessments and educate members about biometric results.
  • Close member care gaps by accurately documenting test results in the clinical record.
  • Present health education classes and programs.
  • Assess prospective customer and member needs to provide effective and efficient customer service.
  • Collaborate with teams to improve the Enterprise STARS rating through targeted member campaigns.
  • Participate in outbound call campaigns for Enterprise Partners, including Commercial, U65, and Medicare teams.
  • Facilitate benefit savings by proactively educating members about benefit plan impacts and choices.
  • Help solve problems and resolve issues, including access-to-care issues.
  • Refer members to community resources such as elder care.
  • Educate prospective customers and members about benefits structure and care-setting alternatives.
  • Educate prospective customers and members and help them access and understand cost and quality comparisons.
  • Refer members to corporate programs such as Healthy Addition, New Directions, and Care Management.
  • Coordinate care for members as appropriate using a personalized care plan.
  • Host customer video appointments.
  • Educate members about digital platforms such as Blue for Me and MeQuilibrium.
  • Travel to multiple locations for work, including meetings, events, and conferences.

Desired Qualifications

  • At least 3 years of managed care, case management, disease management, clinical nursing, home health care, or related experience with hands-on patient interaction.
  • Sales work experience.
  • Knowledge of provider contracting and reimbursement methodologies.
  • Knowledge of member tools such as the Member Portal, and knowledge of care management, disease management, and similar care programs.
  • Knowledge of health and specialty products and the ability to explain how to use benefits in conjunction with specific illnesses.
  • Knowledge of community resources.

About the Company

GuideWell Mutual

Nonprofit mutual health insurance group in Florida

GuideWell Mutual Holding Corporation is the not-for-profit, policyholder-owned parent of Florida Blue, the Blue Cross and Blue Shield health insurer for Florida. Its family of companies also includes Triple-S, which runs the Blue plans in Puerto Rico, and GuideWell Source, which processes Medicare claims for the federal government through Novitas Solutions and First Coast Service Options. Most income comes from health plan premiums paid by employers, individuals and Medicare members, plus fees for running claims for others. As a mutual, it has no shareholders, and Florida Blue policyholders control it. GuideWell was formed in 2013 and is based in Jacksonville, Florida.

Company size
10,001+
Company stage
Not listed
Total funding
Not listed
Headquarters
Jacksonville, FL
Founded
2011

Recently Posted Jobs

Explore more opportunities at GuideWell Mutual

See more jobs