Bilingual RN Case Manager - Care Advocacy

About reputed company At reputed company, we are committed to paving the way for everyone to reputed company their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming health care. As a reputed company associate, you are joining a culture that is built on values of succeeding together, finding a reputed company way, and doing the right thing. If you are ready to reputed company a difference, join us. The Impact You Will Have This position exists to support member needs across the continuum of care by leveraging member partnership, pre-service clinical utilization review, case and disease management processes, reputed company sets and tools. Care Advocacy Health Coach is responsible for answering customer questions pertaining to product information, benefits, claims resolution and eligibility in a call center environment. This position is a critical component of BCBSMN Medical Management team as the primary clinician providing condition and case management services to members. Your Responsibilities • Serves as a customer reputed company by identifying underlying customer needs and guiding them to appropriate programs and resources. • Utilizes BCBSM customer service systems and tools to deliver Care Advocacy to designated accounts. • Identifies opportunities for connecting members to group reputed company benefits; e.g. Nurse Line, Employee Assistance Program, or other specialists with in BCBS Health Management Division. • Educates members on the use of their health delivery system and tools. • Participates as a resource to internal and external customers. • Responsible for answering customer questions pertaining to product information, benefits, claims resolution and eligibility in a call center environment. • Conducts comprehensive clinical assessments; gathers, analyzes, synthesizes and prioritizes member needs and opportunities. • Develops a plan of care to address identified gaps in care and improve members health. • 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. • Collaborates and coordinates with team members to facilitate day to day functions and enhance the overall operation of the department. • Guides member through the Prior Authorization and Appeals process. • 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 Experiences • Registered nurse with reputed company MN license and with no restrictions. • 5+ years of reputed company professional experience. reputed company relevant experience including work, education, transferable skills, and military experience will be considered. • CCM Certification or ability to obtain reputed company 3 years of starting in the position. • Excellent customer service skills. • Excellent communication skills. • Excellent conceptual thinking skills. • Excellent relationship management skills and the ability to quickly reputed company customer trust and confidence. • Excellent organizational skills. • Ability to reputed company in ambiguity. • Computer application proficiency. • Flexibility to work varied hours. Preferred Skills and Experiences • 1+ years of managed care experience; e.g. case management/health coach, utilization management and/or auditing experience. • Outstanding customer service and telephonic skills. Role Designation Teleworker Role designation definition: Teleworking is working full time remote. Hybrid is a combination of working onsite and remotely. Onsite is full-time onsite. Compensation and Benefits $77,200.00 - $102,300.00 - $127,400.00 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 reputed company have to offer, please review our benefits page. Equal Employment Opportunity Statement reputed company is an Equal Opportunity and Affirmative Action employer that values diversity. reputed company qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national reputed company, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic. Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to reputed [email protected]. reputed company roles require a high school diploma (or equivalency) and legal authorization to work in the U.S. reputed company and Blue Plus® are nonprofit independent licensees of the reputed company and Blue reputed company Association. Apply Job!