Population Health Onsite RN

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 SCOPEThis 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 Experience4 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…