Current jobs related to Nurse for Care Coordination - Baton Rouge, Louisiana - Blue Cross and Blue Shield of Louisiana
-
Pediatric Nurse Specialist
2 weeks ago
Baton Rouge, Louisiana, United States Health Care for Kids Full timeAbout UsHealthcare for Kids Inc. is a leading provider of pediatric day health care services for medically fragile children. Our mission is to deliver high-quality care that meets the unique needs of each child and their family.Job SummaryWe are seeking a highly skilled and compassionate Pediatric Registered Nurse to join our team. As a Pediatric Registered...
-
Licensed Practical Nurse
6 days ago
Baton Rouge, Louisiana, United States Louisiana Nurse Staffing Corporation Full timeWe are seeking a dedicated Licensed Practical Nurse to join our team at Louisiana Nurse Staffing Corporation. As a key member of our healthcare team, you will be responsible for providing high-quality care to our residents in skilled nursing facilities and senior living communities.Key Responsibilities:Healthcare Coordination: Collaborate with the healthcare...
-
Licensed Practical Nurse
6 days ago
Baton Rouge, Louisiana, United States Care South Full timeJob SummaryWe are seeking a skilled Licensed Practical Nurse to join our team at Care South. As an LPN, you will play a vital role in providing high-quality patient care in our ambulatory care setting.Key ResponsibilitiesAdminister medications and perform venipuncture as neededImplement and coordinate individualized interdisciplinary plans of care for...
-
Certified Nursing Assistant
4 weeks ago
Baton Rouge, Louisiana, United States Franciscan Missionaries of Our Lady Health System Full timeJob Title: Certified Nursing AssistantFranciscan Missionaries of Our Lady Health System is seeking a skilled Certified Nursing Assistant to join our team in providing high-quality care to our patients.Job Summary:The Certified Nursing Assistant will work closely with the Home Care Coordinator to ensure the seamless delivery of care services to our patients....
-
Certified Nursing Assistant
2 weeks ago
Baton Rouge, Louisiana, United States Our Lady of the Lake Regional Medical Center Full timeJob Title: Certified Nursing AssistantOur Lady of the Lake Regional Medical Center is seeking a Certified Nursing Assistant to join our team. As a Certified Nursing Assistant, you will play a vital role in assisting the Home Care Coordinator with various tasks, including communication with Personal Care Contracted Companies and DME Contracted Companies.Key...
-
Licensed Practical Nurse
6 days ago
Baton Rouge, Louisiana, United States Care South Full timeCare South is seeking a skilled Licensed Practical Nurse to join our team. As an LPN, you will play a vital role in providing high-quality patient care in our ambulatory care setting.**Job Summary:**We are looking for a dedicated and compassionate LPN to work collaboratively with our interdisciplinary healthcare team to deliver exceptional patient...
-
Nursing Assistant
2 weeks ago
Baton Rouge, Louisiana, United States Louisiana Nurse Staffing Corporation Full timeJob SummaryWe're seeking a compassionate and skilled Nursing Assistant to provide exceptional patient care in our nursing unit. As a key member of our team, you will work closely with Registered Nurses to deliver high-quality care that prioritizes patient comfort and well-being.Duties and ResponsibilitiesProvide essential nursing care within the Nursing...
-
Memory Care Program Coordinator
2 weeks ago
Baton Rouge, Louisiana, United States Holly Court Assisted Living & Memory Care Full timeWe are seeking a skilled Memory Care Program Coordinator to join our team at Holly Court Assisted Living and Memory Care. Our inclusive environment allows our diverse team to thrive in providing world-class services to our residents, guests, and each other.The successful candidate will be responsible for delivering high-quality care and services to residents...
-
Medical Care Coordinator
1 week ago
Baton Rouge, Louisiana, United States Avenues Recovery Full timeJob OverviewAvenues Recovery Center is a nationwide network of drug and alcohol rehab centers seeking a skilled Licensed Practical Nurse (LPN) to join our team in Baton Rouge, LA.As a LPN, you will provide high-quality medical care to clients throughout their treatment journey, ensuring their physical and emotional well-being. Your expertise will be...
-
Certified Nursing Assistant
1 month ago
Baton Rouge, Louisiana, United States Our Lady of the Lake Regional Medical Center Full timeJob SummaryWe are seeking a skilled Certified Nursing Assistant to join our team at Our Lady of the Lake Regional Medical Center. As a key member of our Home Care team, you will play a vital role in providing exceptional care to our patients in the comfort of their own homes.Key ResponsibilitiesCommunication: Establish and maintain effective communication...
-
Certified Nursing Assistant
1 month ago
Baton Rouge, Louisiana, United States Louisiana Nurse Staffing Corporation Full timeJob SummaryWe are seeking a dedicated and compassionate Nursing Assistant to support patient care with professionalism and empathy. As a key member of our healthcare team, you will assist patients with daily living activities, provide basic nursing care to non-acutely ill patients, and help maintain a safe and clean environment.Key ResponsibilitiesProvide...
-
Certified Nursing Assistant
3 weeks ago
Baton Rouge, Louisiana, United States Louisiana Nurse Staffing Corporation Full timeJob SummaryWe are seeking a compassionate and skilled Nursing Assistant to support patient care with professionalism and dedication.As a Nursing Assistant, you will assist patients with daily living activities, provide basic nursing care to non-acutely ill patients, and help maintain a safe and clean environment.Duties and ResponsibilitiesProvide essential...
-
Licensed Practical Nurse
2 weeks ago
Baton Rouge, Louisiana, United States Louisiana Nurse Staffing Corporation Full timeJob Title: Licensed Practical NurseAt Louisiana Nurse Staffing Corporation, we are seeking a skilled and compassionate Licensed Practical Nurse to join our dedicated healthcare team.Job SummaryThe successful candidate will provide high-quality patient care, working under the guidance of a Registered Nurse to deliver comprehensive services that address the...
-
Nurse Practitioner
2 weeks ago
Baton Rouge, Louisiana, United States Open Health Care Clinic Full timeJob SummaryThe Open Health Care Clinic is seeking a highly skilled and compassionate Nurse Practitioner to join our team in an outpatient setting. As a key member of our multidisciplinary health team, you will be responsible for providing comprehensive care to patients with acute and chronic illnesses, working collaboratively with physicians and other...
-
Licensed Practical Nurse
4 weeks ago
Baton Rouge, Louisiana, United States Louisiana Nurse Staffing Corporation Full timeJob SummaryWe are seeking a skilled and compassionate Licensed Practical Nurse to join our dedicated healthcare team at the Louisiana Nurse Staffing Corporation. As a Professional Nurse, you will play a vital role in delivering high-quality patient care and contributing to the well-being of our patients and their families.Key ResponsibilitiesPerform thorough...
-
Licensed Practical Nurse
4 weeks ago
Baton Rouge, Louisiana, United States Louisiana Nurse Staffing Corporation Full timeJob SummaryWe are seeking a skilled Licensed Practical Nurse to join our dedicated healthcare team at the Louisiana Nurse Staffing Corporation. As a Professional Nurse, you will play a vital role in delivering high-quality patient care and contributing to the success of our organization.Key ResponsibilitiesPerform thorough head-to-toe assessments and...
-
Nurse Practitioner
1 week ago
Baton Rouge, Louisiana, United States Open Health Care Clinic Full timeJob SummaryWe are seeking a highly skilled Nurse Practitioner to join our multidisciplinary healthcare team at the Open Health Care Clinic. As a key member of our outpatient care team, you will provide comprehensive care to patients with acute and chronic illnesses, working collaboratively with physicians and other healthcare professionals to ensure...
-
Care Coordinator Specialist
6 days ago
Baton Rouge, Louisiana, United States NeuroMedical Center Full timeJob Summary: We are seeking a highly skilled Care Coordinator to join our team at the NeuroMedical Center. This is a critical role that requires strong communication and organizational skills to ensure seamless care coordination for patients with chronic medical issues.Key Responsibilities:Facilitate clinical management and continuity of care for patients...
-
Care Coordinator Specialist
1 month ago
Baton Rouge, Louisiana, United States Home Instead Full timeClient Care Coordinator RoleAt Home Instead, we're seeking a dedicated and compassionate Client Care Coordinator to join our team. As a key member of our client services team, you'll play a vital role in enhancing the lives of aging adults and their families.Key Responsibilities:Conduct care consultations with potential clients and family members to...
-
Pediatric Nurse
2 weeks ago
Baton Rouge, Louisiana, United States Health Care for Kids Full timePediatric Nurse OpportunityWe are seeking a dedicated and compassionate Pediatric Nurse to join our team at Healthcare for Kids Inc. Our Pediatric Day Health Care (PDHC) services provide medically-fragile children with the care they need while their families are unable to provide it.Why Work with Us?Competitive rates and flexible schedulingMedical, dental,...
Nurse for Care Coordination
2 months ago
At Blue Cross and Blue Shield of Louisiana, we prioritize the well-being of our employees, offering resources to promote health, continuous learning, skill development, and professional growth while serving our local communities.
POSITION OBJECTIVE
As part of the Population Health and Health Services team, the role involves a collaborative approach to assess, plan, implement, monitor, and evaluate healthcare options and services tailored to meet the needs of members, providers, and communities. The Care Coordination Nurse will utilize disease management protocols to identify optimal resources that enhance quality and cost-effective outcomes. Additionally, Utilization Review personnel will provide clinical services and member management, ensuring compliance with all relevant laws, regulations, and accreditation standards.
ROLE SCOPE
- This position does not involve personnel management.
- Key Contacts: To effectively execute this role, the incumbent will engage with various internal departments, providers, subscribers, group representatives, reinsurance carriers, the Department of Insurance, other insurance entities, and healthcare vendors.
QUALIFICATIONS
Educational Background
- High School Diploma or equivalent is mandatory.
Professional Experience
- A minimum of 4 years in direct patient care is required.
- Experience in Managed Care or claims processing, along with knowledge of medical terminology and ICD-10 codes, is essential.
- 1 year of experience in medical review and/or authorization is preferred.
Skills and Competencies
- Familiarity with insurance, reinsurance, and customer service operations is preferred.
- Ability to research, analyze cases, and make informed quality and cost-effective decisions.
- Effective communication skills with members, providers, pharmacy staff, and colleagues at all organizational levels are crucial.
- Detail-oriented, organized, and self-motivated individuals will thrive in this role.
- Must demonstrate professional judgment and the ability to delegate tasks while managing multiple responsibilities.
- Proficiency in relevant software and office equipment is necessary.
- Understanding of Medicare guidelines and accountability for decisions based on these guidelines is required.
- Knowledge of coding guidelines for ICD, HCPCS, and CPT is preferred.
Licenses and Certifications
- Licensed Practical Nurse (LPN) - Must hold a current state license to practice in Louisiana, having graduated from an accredited vocational or technical school for Practical Nursing.
- Certification as a Professional in Disease Management or Health Care Management is required for 2 years.
- Certification in Utilization Review or Managed Care is required for 2 years.
KEY RESPONSIBILITIES
- Evaluate member status by gathering comprehensive information regarding the patient's situation to identify needs and develop a comprehensive disease management plan.
- Formulate and implement a plan by establishing specific objectives, goals, and actions based on the assessment.
- Execute targeted interventions to achieve the goals set in the plan.
- Coordinate resources effectively to meet established goals.
- Monitor the effectiveness of the plan by collecting relevant information from various sources.
- Meet performance targets for staff and unit to maximize program value and achieve departmental productivity goals.
- Engage in care coordination or Utilization Management as directed by RN and/or clinical leadership.
- Research and interpret contract benefits to ensure accurate benefit administration and fulfill authorization requirements.
- Conduct medical necessity reviews based on patient conditions using established review criteria and guidelines.
- Address and resolve issues related to benefit utilization, collaborating with internal and external customers to coordinate care for authorized services.
- Negotiate payment rates when provider network deficiencies arise and document care management savings to initiate programs and identify enhancement opportunities.
- Communicate with members and providers regarding contract requirements and gather relevant care information to facilitate member management.
- Ensure timely management of verbal notifications and written materials to comply with regulatory and operational guidelines.
- Serve as a technical resource for non-clinical staff by providing support in interpreting clinical information during the review process.
ADDITIONAL RESPONSIBILITIES
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform these functions.
- Perform other job-related duties as assigned within the scope of responsibilities.
- Work is primarily conducted in a standard office environment with typical noise levels.
- Job duties involve standing or sitting for extended periods.
- Skills in comprehension, documentation, calculation, visualization, and analysis are required.
AN EQUAL OPPORTUNITY EMPLOYER
Blue Cross and Blue Shield of Louisiana is committed to fostering a diverse and inclusive workplace.
