Care Coordination Nurse

4 days ago


Baton Rouge, Louisiana, United States Blue Cross and Blue Shield of Louisiana Full time
Job Summary

We are seeking a highly skilled and experienced Care Coordination Nurse to join our team at Blue Cross and Blue Shield of Louisiana. As a key member of our Population Health team, you will play a critical role in ensuring our members receive high-quality, cost-effective care.

Key Responsibilities
  • Assess member needs and develop comprehensive disease management plans to address their healthcare requirements.
  • Collaborate with healthcare providers, internal departments, and external stakeholders to coordinate care and ensure seamless transitions.
  • Utilize clinical expertise to review medical necessity and make informed decisions regarding authorization and denial of services.
  • Communicate effectively with members, providers, and internal teams to ensure timely and accurate information exchange.
  • Monitor and evaluate the effectiveness of care coordination efforts and make data-driven decisions to improve outcomes.
Requirements
  • 4 years of direct patient care experience, preferably in a managed care or utilization review setting.
  • Knowledge of medical terminology, ICD-10 codes, and insurance operations.
  • Ability to work independently and as part of a team, with excellent communication and interpersonal skills.
  • Strong analytical and problem-solving skills, with the ability to make sound judgments and decisions.
  • Current licensure as a Licensed Practical Nurse (LPN) in the state of Louisiana.
Preferred Qualifications
  • Certification in disease management, healthcare management, or utilization review.
  • Experience with electronic health records and related software applications.
  • Knowledge of Medicare guidelines and coding systems.
What We Offer
  • A dynamic and supportive work environment with opportunities for professional growth and development.
  • A competitive salary and benefits package, including medical, dental, and vision coverage.
  • A comprehensive training program to ensure your success in this role.


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