Care Coordination Nurse
3 weeks ago
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 Blue Cross.
Residency in or relocation to Louisiana is preferred for all positions.
POSITION PURPOSEStaff in the Population Health and Health Services area: Utilize a collaborative process to assess, plan, implement, monitor and evaluate options and services required to meet the member’s, providers’ and communities’ healthcare needs. Utilizing the disease management referral and assessment process, the disease management nurse will identify the most appropriate resources to promote quality, cost effective outcomes. Utilization Review staff are responsible for providing clinical service and/or member management. 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 Necessary Contacts: In order to effectively fulfill this position the incumbent must be in contact with:All internal departments, providers, subscribers, group representatives, reinsurance carriers, Department of insurance, other insurance carriers, and healthcare vendors. QUALIFICATIONS
Education High School Diploma or equivalent required Work Experience 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 Skills and Abilities Prefer 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. Must be detail oriented, organized, and self motivated. Must use appropriate professional judgment and be able to make decisions and delegate work appropriately while working on multiple tasks. Working knowledge of related software and office equipment.
Ability to comprehend Medicare guidelines and assume responsibility for decisions based on these Guidelines is required.
Knowledge of coding guidelines for ICD, HCPCS and CPT preferred.
Licenses and Certifications Health Services\LPN - Licensed Practical Nurse - State Licensure currently licensed to practice in Louisiana with graduation from an accredited vocational or technical school for Practical Nursing 180 days required Certified Professional in Disease Management or Health Care Management 2 years required Certification in Utilization Review or Managed Care 2 years required ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS 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 that will address needs.
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.
Responsible for meeting targets for staff and unit performance to maximize program value and ensure achievement of department productivity goals.
Care coordination or Utilization Management as designated by RN and/or clinical leadership.
Researches and interprets contract benefits to facilitate accurate benefit administration and fulfill product-specific authorization requirements.
Conducts medical necessity reviews based upon the patient's condition and/or symptoms utilizing medically-accepted review criteria/guidelines, medical delegations and/or policies to provide quality healthcare and meet regulatory requirements.
Responsible for reviewing, resolving, and responding to issues regarding utilization of benefits. Works closely with internal and external customers to coordinate appropriate care for authorized services.
Negotiates rate of payment when provider network deficiency exists and accurately calculates and documents care management savings to initiate care management programs, identify product enhancement opportunities, and capture returns on investments (ROI).
Communicates directly with members and/or providers regarding contract requirements and collects relevant planned care information via telephone to facilitate member management.
Responsible for timely management for appropriate verbal notifications and/or written materials to ensure compliance with regulatory and/or operational guidelines.
Responsible for meeting targets for staff and unit performance to maximize program value and ensure achievement of department productivity goals.
Serves as a technical resource to the non-clinical staff by responding to inquiries regarding the interpretation of clinical information to provide clinical support for non-clinical staff involved in the review process. 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 BCBSLA 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 for assistance.
In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages 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.
Blue Cross and Blue Shield of Louisiana performs 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, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.
-
Nurse Care Manager
2 months ago
Baton Rouge, United States Louisiana Primary Care Association Full time $31,900 - $59,200Louisiana Primary Care AssociationPosition DescriptionPosition Title: Nurse Care ManagerFull-time ExemptSupervisor: Director of Managed Care and Network DevelopmentPosition Summary: The Nurse Care Manager is responsible for developing patient care plans while providing patient education, guidance, and support, as well as maintaining a comprehensive care...
-
Nurse Care Manager
4 weeks ago
Baton Rouge, United States Louisiana Primary Care Association Full time $31,900 - $59,200Louisiana Primary Care AssociationPosition DescriptionPosition Title: Nurse Care ManagerFull-time ExemptSupervisor: Director of Managed Care and Network DevelopmentPosition Summary: The Nurse Care Manager is responsible for developing patient care plans while providing patient education, guidance, and support, as well as maintaining a comprehensive care...
-
Care Coordination Nurse
2 weeks ago
Baton Rouge, United States Blue Cross and Blue Shield of Louisiana Full timeWe 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 Blue Cross. Residency in or relocation to Louisiana is preferred for all positions. POSITION PURPOSE Staff in the Population Health and...
-
Memory Care Program Coordinator
2 weeks ago
Baton Rouge, Louisiana, United States Holly Court Assisted Living & Memory Care Full timeHolly Court Assisted Living and Memory Care At Holly Court Assisted Living and Memory Care , we believe that everyone should be treated withrespect. Our inclusive environment allows our diverse team to thrive inproviding world-class services to our residents, guests, and each other. We arein need of a dynamic Memory Care Program Coordinator to excel with our...
-
Wound Care Coordinator
1 month ago
Baton Rouge, United States KPC Promise Healthcare LLC Full timeJob DescriptionJob DescriptionKPC Promise Hospital of BATON ROUGE: The Wound Care Coordinator is responsible for monitoring and maintaining the Wound Care program as directed by management. Responsibilities include education, data reporting, supervising employees, as well as providing direct and indirect patient care, implementation and evaluation of care in...
-
Care Coordinator
4 weeks ago
Baton Rouge, United States Phamily Full timeTHE NEUROMEDICAL CENTER CLINICJOB DESCRIPTIONPOSITION TITLE: Care CoordinatorDEPARTMENT:REPORTS TO: Director of Clinical SystemsRevision date:GENERAL SUMMARY OF DUTIESThis position is the center point for outpatient care of patients with chronic medical issues such as Chronic Pain, Stroke, Multiple Sclerosis, Parkinson’s, Dementia, Cancers, and others...
-
Care Coordinator
4 weeks ago
Baton Rouge, United States Phamily Full timeTHE NEUROMEDICAL CENTER CLINICJOB DESCRIPTIONPOSITION TITLE: Care CoordinatorDEPARTMENT:REPORTS TO: Director of Clinical SystemsRevision date:GENERAL SUMMARY OF DUTIESThis position is the center point for outpatient care of patients with chronic medical issues such as Chronic Pain, Stroke, Multiple Sclerosis, Parkinson’s, Dementia, Cancers, and others...
-
Care Coordinator
2 months ago
Baton Rouge, United States Phamily Full timeTHE NEUROMEDICAL CENTER CLINICJOB DESCRIPTIONPOSITION TITLE: Care CoordinatorDEPARTMENT:REPORTS TO: Director of Clinical SystemsRevision date:GENERAL SUMMARY OF DUTIESThis position is the center point for outpatient care of patients with chronic medical issues such as Chronic Pain, Stroke, Multiple Sclerosis, Parkinson’s, Dementia, Cancers, and others...
-
Care Coordinator
2 months ago
Baton Rouge, United States Phamily Full timeTHE NEUROMEDICAL CENTER CLINICJOB DESCRIPTIONPOSITION TITLE: Care CoordinatorDEPARTMENT:REPORTS TO: Director of Clinical SystemsRevision date:GENERAL SUMMARY OF DUTIESThis position is the center point for outpatient care of patients with chronic medical issues such as Chronic Pain, Stroke, Multiple Sclerosis, Parkinson’s, Dementia, Cancers, and others...
-
Coordinator, Care Services
1 day ago
Baton Rouge, United States The ALS Association Full timeJob DescriptionJob Description Established in 1985, The ALS Association is the only national nonprofit organization fighting ALS on every front. By leading the way in global research, providing assistance for people with ALS through a nationwide network of chapters, coordinating multidisciplinary care through certified clinical care centers, and fostering...
-
Coordinator, Care Services
5 days ago
Baton Rouge, United States The ALS Association Full timeJob DescriptionJob Description Established in 1985, The ALS Association is the only national nonprofit organization fighting ALS on every front. By leading the way in global research, providing assistance for people with ALS through a nationwide network of chapters, coordinating multidisciplinary care through certified clinical care centers, and fostering...
-
Referral Coordinator
4 weeks ago
Baton Rouge, United States Open Health Care Clinic Full timeJob DescriptionJob DescriptionJob Purpose: The Referral Care Coordinator requires direct patient communication, critical thinking and problem solving. The position works closely with the clinical staff and outside agencies to ensure timely processing, tracking and follow-up of external and internal referrals. This position is also responsible for the timely...
-
Referral Coordinator
1 week ago
Baton Rouge, United States Open Health Care Clinic Full timeJob DescriptionJob DescriptionJob Purpose: The Referral Care Coordinator requires direct patient communication, critical thinking and problem solving. The position works closely with the clinical staff and outside agencies to ensure timely processing, tracking and follow-up of external and internal referrals. This position is also responsible for the timely...
-
Administrative Coordinator
2 months ago
Baton Rouge, United States Louisiana Primary Care Association Full time $39,250 - $72,950Louisiana Primary Care AssociationPosition Title: Administrative CoordinatorFull-time ExemptSupervisor: Director of Managed Care and Network DevelopmentPosition Summary: The Administrative Coordinator is responsible for supporting the Network Director, ACO staff, and members in monthly meetings of the board of directors and network committees, drafting...
-
Administrative Coordinator
4 weeks ago
Baton Rouge, United States Louisiana Primary Care Association Full time $39,250 - $72,950Louisiana Primary Care AssociationPosition Title: Administrative CoordinatorFull-time ExemptSupervisor: Director of Managed Care and Network DevelopmentPosition Summary: The Administrative Coordinator is responsible for supporting the Network Director, ACO staff, and members in monthly meetings of the board of directors and network committees, drafting...
-
Client Care Coordinator
2 weeks ago
Baton Rouge, Louisiana, United States Home Instead Full timeHome Instead is proud to work with organized individuals that help in our mission to enhance the lives of aging adults and their families. The Client Care Coordinator is expected to perform a variety of duties that relate to client care including care consultations with potential clients and family members, client/Care Professional introductions and quality...
-
Client Care Coordinator
2 months ago
Baton Rouge, United States Home Instead Full timeHome Instead is proud to work with organized individuals that help in our mission to enhance the lives of aging adults and their families. The Client Care Coordinator is expected to perform a variety of duties that relate to client care including care consultations with potential clients and family members, client/Care Professional introductions and quality...
-
Insurance Coordinator
4 weeks ago
Baton Rouge, United States Fresenius Medical Care Full timePURPOSE AND SCOPE: Explores, recommends, and coordinates the insurance and potential financial assistance options available to kidney dialysis patients in a specified geographic area, while maximizing revenue for the company. Supports FMCNA's mission, vision, core values and customer service philosophy. Adheres to the FMCNA Compliance Program, including...
-
Pharmacy Technician
1 month ago
Baton Rouge, United States Vital Care of Baton Rouge Full timeJob DescriptionJob DescriptionJob Summary:We are seeking an Pharmacy Technician / Intake Coordinator to join our constantly growing Vital Care of Baton Rouge team. The Pharmacy Technician / Intake Coordinator will be responsible for communicating with patients and referral sources in a professional manner, verifying insurance eligibility, maintaining...
-
Referral Coordinator
4 weeks ago
Baton Rouge, United States Open Health Care Clinic Full timeJob DescriptionJob DescriptionJob Purpose: The Referral Coordinator requires direct patient communication, critical thinking and problem solving. The position works closely with the clinical staff and outside agencies to ensure timely processing, tracking and follow-up of external and internal referrals. This position is also responsible for the timely...
