Care Coordination Nurse I

Job not on LinkedIn

🔥 12 minutes ago

⚜️ Louisiana – Remote

⚜️ Louisiana – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 12%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Blue Cross and Blue Shield of Louisiana

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1934

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

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

• Assess members’ status by collecting in-depth patient information and identifying needs • Develop and implement comprehensive disease management plans with specific objectives, goals, and actions • Implement interventions to accomplish established goals • Coordinate, organize, integrate, and modify resources needed to accomplish goals • Monitor plans by gathering information and evaluating effectiveness • Meet staff and unit performance targets and department productivity goals • Perform care coordination or Utilization Management as designated by RN and/or clinical leadership • Research and interpret contract benefits to facilitate accurate benefit administration and product-specific authorization requirements • Conduct medical necessity reviews using accepted criteria, guidelines, medical delegations, and policies • Review, resolve, and respond to utilization-of-benefits issues and coordinate appropriate care • Negotiate payment rates when provider network deficiencies exist • Calculate and document care management savings, identify product enhancement opportunities, and capture ROI • Communicate with members and providers regarding contract requirements and collect planned-care information by telephone • Manage verbal notifications and written materials in compliance with regulatory and operational guidelines • Serve as a technical resource to non-clinical staff by interpreting clinical information • Perform other job-related duties within scope of responsibilities

🎯 Requirements

• High School Diploma or equivalent required • 4 years of direct patient care experience required • Managed Care or claims processing experience • Knowledge of medical terminology and ICD-10 codes • Current, unrestricted LPN license in Louisiana and/or required jurisdictions where services are provided • CPUR, CPC, or CMCN certification preferred upon hire and required within 24 months in position • Knowledge of insurance, reinsurance, and/or customer service operations preferred • Ability to research and analyze cases and make quality and cost-effective decisions • Effective communication with members, providers, pharmacy staff, and employees at all organizational levels • Detail-oriented, organized, and self-motivated • Professional judgment and ability to make decisions and delegate work appropriately while managing multiple tasks • Working knowledge of related software and office equipment • Ability to comprehend Medicare guidelines and assume responsibility for guideline-based decisions • Knowledge of ICD, HCPCS, and CPT coding guidelines preferred • Ability to work in the United States without employer-sponsored immigration support • Residency in or relocation to Louisiana preferred

🏖️ Benefits

• Employee resources to live well, be healthy, continue learning, develop skills, grow professionally, and serve local communities • Reasonable accommodations for individuals with disabilities • Smoke- and tobacco-free work environment • Pre-employment drug screening and background screening