Remote100% remote; preference given to current employees and candidates residing in Arkansas. Preference is given to candidates who reside in Arkansas.
Medical, Clinical & Veterinary
About the job
Requirements
A bachelor's degree in Nursing is preferred.
A Registered Nurse (RN) with a current active state license in good standing in the state or states where job duties are performed is required.
Case Management certification is preferred.
At least four years of clinical practice nursing experience in medical-surgical nursing, surgical nursing, intensive care, or critical care nursing is required.
Proficiency in basic Microsoft Office computer skills, including Word, Excel, and Outlook, and ability to navigate multiple systems and perform keyboarding are required.
Ability to prioritize and make sound nursing judgments through critical thinking is required.
Ability to interpret complex documentation is required.
Ability to work independently with little supervision is required.
Excellent oral and written communication skills and ability to build collaborative relationships are required.
Preference is given to current employees and candidates who reside in Arkansas.
Responsibilities
Assess members for needed community resources, vendor assistance, case management services, and other interdisciplinary services associated with Clinical Services and Population Health.
Answer and route calls to support the Clinical Services and Population Health division, including warm transfers to and from customer service, case management, support services, and other resources as appropriate.
Promote communication through available channels, including mobile applications.
Facilitate collaboration among patients, families or caregivers, physicians, hospital discharge planners, home care providers, and other ancillary providers to promote quality of care, cost effectiveness, accessibility, and appropriate service levels.
Practice nursing within the scope of licensure and adhere to policies, procedures, regulations, URAC standards, and applicable state regulations; make decisions based on facts and evidence to support compliance, appropriate levels of care, and patient safety.
Remain current with medical and surgical procedures, products, healthcare services and drugs, healthcare delivery trends, and enterprise procedures, policies, and contracts.
Assess and resolve gaps in patient care related to chronic health conditions through health education and case management services, ensuring gaps are closed promptly.
Promote appropriate care and quality, and support cost effectiveness and cost containment based on evidence.
Proactively work with referrals from multiple sources to identify candidates with gaps in care for case management, explain services, obtain voluntary agreement to services, and maintain a minimum patient caseload promptly.
Perform other duties as assigned.
Desired Qualifications
Case Management certification.
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
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.