Population Health RN – Part-Time

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⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

⏱ Part Time

🟡 Mid-level

🟠 Senior

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Blue Cross and Blue Shield of Louisiana

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1934

⚕️ Healthcare Insurance

Healthcare Insurance

Blue Cross and Blue Shield of Louisiana is an independent licensee of the Blue Cross Blue Shield Association, offering a range of health insurance products and services in the state of Louisiana. The company provides health, dental, and travel insurance options, including Medicare Advantage plans such as HMO and PPO. They focus on delivering comprehensive healthcare coverage through various plans to meet varying customer needs, while partnering with doctors, hospitals, and clinics to ensure quality care and support. Additionally, the company emphasizes wellness programs, cost-saving opportunities, and accessibility for its members.

📋 Description

• Responsible for organizing, coordinating, and providing care coordination and case management services to members who are most at risk for health deterioration, sentinel events, and/or poor outcomes • Manage acute and chronically ill members to improve health and financial outcomes through analysis of needs, design, and delivery of interventions • Utilize a collaborative process to assess, plan, implement, monitor, and evaluate options and services required to meet the member’s healthcare needs • Through communication, the nurse will identify available resources to promote quality, cost effective outcomes • Accountable for complying with all laws, regulations and accreditation standards that are associated with duties and responsibilities • Develop and implement a plan by determining specific objectives, goals, and actions as identified through the assessment in action oriented and time specific indicators. • The case manager will act as an advocate for the member/family, maintaining privacy, confidentiality and safety, building relationships with all relevant parties, supporting informed decision making and facilitating access to necessary and appropriate healthcare services across the continuum of care. • Implement a comprehensive case management plan • Implement specific case management activities and/or interventions and evaluate effectiveness that will lead to accomplishing the goals established in the case management plan. • Coordinate by collaborating with the member/family, providers, third party payors, employers and community resources in order to organize, integrate, and modify the resources necessary to accomplish the goals. • Interacts with patients and/or providers in order to determine patient care needs, compliance and effectiveness with planned interventions and conduct case conferences as appropriate. • Evaluates the case management plan’s effectiveness in reaching desired outcomes and goals. • Modifies any or all of the case management plan’s components if necessary. • Responsible for meeting individual quality performance standards and annual targets for program performance, such as monthly productivity and annual caseload requirements, as mutually agreed to by management team to maximize program value.

🎯 Requirements

• Diploma in nursing or Associate’s in nursing or Bachelor's in nursing required • 3 years of recent direct patient care/clinical experience is required • 2 years of experience in managed care is preferred • Experience in the use of behavioral interviewing techniques and theory is preferred • Requires the ability to prioritize, work independently and anticipate needs to make decisions • Ability to plan, implement and evaluate appropriate healthcare services in conjunction with a physician treatment plan and evaluate the effectiveness of alternate care services are required • Requires the ability to research and analyze contracts/cases and make appropriate quality and cost effective decisions • Knowledge of standardized code sets and medical terminology is required • 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 • Requires working knowledge of related software and office equipment. • Active and unencumbered(current and unrestricted) RN license to practice in Louisiana is required • Multi-state Compact RN license is preferred • Multi-state Compact RN license is required within 6 months from date of hire • 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.

🏖️ Benefits

• We take great strides to ensure our employees have the resources to live well • Be healthy • Continue learning • Develop skills • Grow professionally • Serve our local communities