We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with us.

Residency in or relocation to Louisiana is preferred for all positions.

Applicants must be authorized to work for Louisiana Blue in the United States without employer-sponsored immigration support. Louisiana Blue will not provide current or future employment-based immigration sponsorship or other immigration support for this opportunity, including H-1B, L-1, O-1, H-1B1, E-3, TN, or J-1 sponsorship or F-1 OPT/STEM OPT/CPT support. Applicants who would require such sponsorship or employer support during their employment should not pursue this opportunity.

POSITION PURPOSE

Provides on-site face-to-face care management services to members at specific client office building sites to comply with contractual obligations. Identifies employees with certain chronic health conditions, reviews medical treatment, claims, coordination of care, gaps in care and care needs to design and deliver care interventions designed to improve health and financial outcomes. Utilizes a collaborative, multi-disciplinary process to assess, plan, implement, monitor, and evaluate options and services required to meet the healthcare needs of individuals. Establishes personal relationships with employees, coaches members and promotes wellness activities designed to increase their personal health accountability and improve their overall health. Primarily serves as a health coach and refers clients to appropriate Blue Cross representatives to address specific issues and, determine possible solutions, including but not limited to customer service, claims, appeals and network. Accountable for complying with all laws, regulations and accreditation standards that are associated with duties and responsibilities.

NATURE AND SCOPE

• This role does not manage people
• This role reports to this job: MANAGER, POPULATION HEALTH
• Necessary Contacts: In order to effectively fulfill this position the incumbent must be in contact with: Benefits Administration, Medical Director, Underwriting, Group leaders, Delegated Vendors, Legal Department and other employees as needed, physicians/staff, hospital administrators/staff, providers, caregivers, subscribers, community resources.

QUALIFICATIONS

Education

• Diploma, Associate’s, Bachelor's or Master’s Degree in nursing

Work Experience

• 4 years of experience in a clinical care setting required.
• 2 years leadership experience preferred.
• Experience working in a stand-alone capacity at an offsite facility preferred.
• Experience in the use of behavioral interviewing techniques and theory is preferred.

Skills and Abilities

• Requires the ability to work independently and anticipate needs to make decisions with minimal supervision, implement and evaluate appropriate healthcare services in conjunction with a physician treatment plan evaluating the effectiveness of alternate care services.
• Utilizing a variety of data resources, have the ability to research and analyze contracts/cases/populations and make appropriate quality and cost effective decisions is required.
• Also must demonstrate excellent interpersonal, organizational, analytical, and telephonic skills.
• Must demonstrate strong communication skills, including the ability to effectively explain/present claims information and procedures to persons with varied levels of insurance/benefits understanding.
• Utilizing a variety of educational programs and resources, as needed perform community liaison duties, coordinating, collaborating with providers and BC vendors; organizing of group educational opportunities. Be subject matter expert on a variety of programs available to assist member with improved health outcomes.
• Requires working knowledge of related software and office equipment.

Licenses and Certifications

• Active and unencumbered(current and unrestricted) RN license to practice in Louisiana is required.
• Multi-state Compact RN license is preferred.
• RN license in noncompact state is preferred.
• May be required to obtain additional RN licensure in noncompact state within 6 months from date of hire.
• Certified Case Management Certification is preferred.
• Certified Case Management Certification is required within 3 years from date of hire.

ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS

• Assists with development of care pathways, onsite condition specific and wellness training programs, and evaluation of specific population needs in order to ensure continuous quality improvement (CQI). As needed, assesses and coaches others on behavioral interviewing and engagement techniques.
• Assess member’s status utilizing behavioral interviewing techniques, by collecting in-depth information in culturally competent and confidential manner, about the member’s situation and functioning to identify individual needs in order to develop and implement a comprehensive individualized care plan. The nurse will act as an advocate for the member/family, maintaining privacy, confidentiality, and safety, building relationships with all relevant parties.
• Complies with management requests for special projects and/or assignments of a non-routine nature. Develops formal recommendations and plans for process improvements and presents to supervisor and/or manager for consideration. Responsible for meeting annual targets for program performance as mutually agreed to by management team to maximize program value. Participates in quality improvement projects and data analysis to determine effectiveness of the program. Assists management with maintaining department timeliness standards and participating or acting as lead on cross-department projects.
• Interacts telephonically and face to face with patients in order to determine patient care needs, compliance and effectiveness with planned interventions, conduct case conferences as appropriate and connecting with appropriate provider and community resources.
• Utilizes appropriate professional nursing judgment in application of contractual benefits and limitations, administrative directives, and claims policy in order to direct the appropriate course of action throughout the continuum of care and refer to appropriate resources to verify benefits.

Additional Accountabilities and Essential Functions
The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions

• Perform other job-related duties as assigned, within your scope of responsibilities.
• Job duties are performed in a normal and clean office environment with normal noise levels.
• Work is predominately done while standing or sitting.
• The ability to comprehend, document, calculate, visualize, and analyze are required.

An Equal Opportunity Employer

All internal employees please apply through Workday Careers.

PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI)

Additional Information

Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account. 

If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact [email protected] for assistance.

In support of our mission to improve the health and lives of Louisianians, we encourage the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free. 

We perform background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.

Additionally, we are a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.