Care Coordination Nurse
1 week ago
We are seeking a skilled Care Coordination Nurse to join our team at Blue Cross and Blue Shield of Louisiana. As a key member of our Population Health and Health Services department, you will play a critical role in assessing, planning, implementing, and evaluating options and services to meet the healthcare needs of our members.
Key Responsibilities- Assess member's status by collecting in-depth information about the patient's situation and functioning to identify needs in order to develop and implement a comprehensive disease management plan.
- Develop and implement a plan by determining specific objectives, goals, and actions as identified through the assessment in action-oriented and time-specific indicators.
- Implement specific interventions that will lead to accomplishing the goals established in the plan.
- Coordinate by organizing, integrating, and modifying the resources necessary to accomplish the goals.
- Monitor by gathering sufficient information from relevant sources in order to determine the effectiveness of the plan.
- High School Diploma or equivalent required.
- 4 years of direct patient care experience required.
- Managed Care or claims processing experience and knowledge of medical terminology and ICD 10 codes required.
- 1 year of medical review and/or authorization experience preferred.
- Knowledge of insurance, reinsurance, and/or customer service operations.
- Ability to research and analyze cases and make appropriate quality and cost-effective decisions.
- Must be able to communicate effectively with members, providers, pharmacy staff, and fellow employees at all levels of the organization.
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.
Job duties are performed in a normal and clean office environment with normal noise levels. Work is predominately done while standing or sitting.
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