At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic.
Blue Cross and Blue Shield of Minnesota
Position Title: RN Case Manager - Self Insured TOC
Location: Remote
Career Area: Health Services
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.
The Impact You Will Have
The Case Manager is a critical component of BCBSMN Care Management team as the primary clinician providing condition and case management services to members. The position exists to support member needs across the continuum of care by leveraging member partnership, case and disease management processes, skill sets and tools.
Your Responsibilities
- 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.
Required Skills and Experience- Registered Nurse licensure in the state of Minnesota 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 Experience- 1+ years of managed care experience; e.g. case management/health coach, utilization management and/or auditing experience.
- Outstanding telephonic skills.
Compensation and Benefits:Pay Range: $67,200.00 - $89,100.00 - $111,000.00 Annual
Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.
We offer a comprehensive benefits package which may include:
- Medical, dental, and vision insurance
- Life insurance
- 401k
- Paid Time Off (PTO)
- Volunteer Paid Time Off (VPTO)
- And more
To discover more about what we have to offer, please review our benefits page.
Equal employment opportunity, including veterans and individuals with disabilities.
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