Case Management RN

About the position

The Case Manager position at Blue Cross involves a collaborative process to assess, plan, implement, monitor, and evaluate healthcare services for members. The role focuses on identifying resources to promote quality and cost-effective outcomes while ensuring compliance with relevant laws and regulations. This position does not involve managing people and requires effective communication with various stakeholders to fulfill the healthcare needs of members.

Responsibilities

• Assess member's status by collecting in-depth information in a culturally competent and confidential manner.
• Develop and implement a comprehensive case management plan addressing individual needs for moderated to high-risk cases.
• Act as an advocate for the member/family, maintaining privacy and confidentiality while facilitating access to healthcare services.
• Implement specific interventions and evaluate their effectiveness in achieving established goals.
• Coordinate with members, providers, payors, and community resources to organize and modify necessary resources.
• Meet annual targets for program performance and participate in quality improvement projects.
• Conduct case conferences with members, providers, and facilities as appropriate.
• Provide guidance to less experienced nurses when necessary.

Requirements

• Bachelor's degree in nursing, business administration, healthcare, or a related field, or equivalent experience.
• 2 years of direct patient care/clinical experience required.
• Registered Nurse (RN) license to practice in Louisiana required.
• Strong communication skills to explain claims information to individuals with varying levels of understanding.
• Excellent organizational and analytical skills.

Nice-to-haves

• RN license to practice in states other than Louisiana (must attain within 12 months after hire).
• Case Management Certification (to be attained within 48 months after hire).

Benefits

• Health insurance coverage
• Professional development opportunities
• Flexible scheduling options
• Paid holidays
• Wellness programs