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We live out our mission to improve the health and lives of Louisianians each day with our friends and neighbors in mind.
Care Coordination Nurse
Location
United States
Posted
78 days ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
Care Coordination Nurse
Blue Cross and Blue Shield of Louisiana
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 - Current, unrestricted LPN license in the state of Louisiana and/or in the required jurisdictions, or where services are provided with graduation from an accredited vocational or technical school for Practical Nursing (180 days required) - Current, unrestricted Certified Professional in Disease Management or Health Care Management license/certification in the state of Louisiana and/or in the required jurisdictions, or where services are provided (2 years required) - Current, unrestricted Certification in Utilization Review or Managed Care in the state of Louisiana and/or in the required jurisdictions, or where services are provided (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 recruiting@bcbsla.com 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.
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Role Description The Neighbor Services Department works directly with neighbors to provide information about the Supplemental Nutrition Assistance Program (SNAP) and provide community partners with information and food resources. Outreach Interns support this work by sharing clear, accurate information about SNAP and helping applicants understand if they may be eligible for support through screenings, scheduling appointments, and referring to other support. They engage with community members at events, partner sites, and in our Brooklyn Park office, working to dispel misconceptions and increase access to food resources. Interns also provide administrative support to the Neighbor Services team, participate in meetings and trainings, and build skills in community outreach, public speaking, and intercultural communication. 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Desired Qualifications - Applicants in the St James/Mankato and St Cloud area are encouraged to apply. - Applicants who are bilingual in English and another language commonly spoken in Minnesota are strongly encouraged to apply. - Some languages in demand in the communities served include Spanish, Hmong, Somali, Karen and Russian. Time Requirements and Schedule - Work sites: - If located in the Twin Cities metro area, Second Harvest Heartland office site in Brooklyn Park, as well as various partner sites throughout the Twin Cities metro. - If located in the St. James/Mankato area or St. Cloud area, work sites will be remote. - Total time requirement: 6 months; 12-20 scheduled hours per week. - Orientation and Initial training: 1-3 full days in-office in Brooklyn Park. - Days of the week: Flexible but scheduled in advance. Generally, Monday through Friday with the opportunity for occasional weekend hours. - Time of the day: Flexible but scheduled in advance. Generally, 8:00 am – 4:30 pm; some evening and weekend opportunities. Professional Development Objectives - Making concrete, positive changes in the food security of households in Minnesota. - Become a knowledgeable advocate for SNAP and CSFP and other social assistance programs such as WIC, Medical Assistance, etc. - Increase personal comfort and confidence with direct service to a wide variety of populations served by Second Harvest Heartland. - Learn to work independently while serving an integral role within a broader collaborative team. - Be introduced to the inner workings of a successful non-profit and develop a range of outreach skills. - Gain exposure to a variety of program models by working closely with other non-profits and community organizations. - Increase understanding of state and federal policies regarding federally funded programs. Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Environmental Demands The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Second Harvest Heartland is an EEO/AA Employer.
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Description Are you looking to join a company that makes a difference? Do you want to be part of an organization with a commitment to an inclusive and supportive culture? Do you enjoy company-wide staff events with opportunities for team building and getting to know your co-workers? Join our team of compassionate, empathetic, and dedicated staff! With a career at Riveon Mental Health and Recovery, you’ll partner with a talented group of individuals in a team atmosphere, including a supportive and knowledgeable leadership team. You’ll also have access to a wealth of opportunities for your personal growth and development. Riveon Mental Health and Recovery is a leader in providing behavioral health services to adults, adolescents, and children. We engage people in our community to achieve mental and emotional well-being through prevention, treatment, and advocacy. With the merger of The LCADA Way and The Nord Center, at Riveon Mental Health and Recovery we have the opportunity to provide integrated behavioral health care with cutting edge treatments and interventions in a supportive environment. We are looking for passionate, caring, and dedicated counselors and social workers to provide office-based and telehealth services to our clients. Responsibilities include providing psychotherapy services to adults and/or children, psychosocial and diagnostic assessments, completing treatment plans, and providing individual and group counseling. We value our team members and provide an excellent total rewards package of benefits and perks designed to be customizable to your specific needs. 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Registered Dietitian
Quad GraphicsQuad Graphics is a leading, multi-channel provider of marketing services for companies around the world. The company started as a small print shop in 1971, work
Title: Registered Dietitian Location: Sussex United States Job Description: Creating a better way. It's more than just the philosophy we were founded on. It's our purpose. For our employees, it means more time with patients. Unrushed visits to build meaningful relationships. And most importantly, an opportunity to empower our patients to achieve their full potential - at work and in life. Determined to make a difference? Join our health care revolution and be a part of something better. QuadMed is looking for a Full time Registered Dietitian Nutritionist (RDN) to join our Health Center with Quad. The ideal candidate will be able to work in the West Allis and/or Sussex, WI health centers a few days a week. This position does have the option to work fully remote as well. This position will work Monday-Friday and the ideal schedule will vary with shifts ranging from 7am-4pm and 8am-5pm. Candidates licensed as a RDN in multiple states is a plus! GENERAL PURPOSE OF JOB The Registered Dietitian Nutritionist provides individual and group nutrition counseling and education to enhance the health and wellness of employees and their families. Primary responsibilities include counseling individuals on daily nutrition and medical nutrition therapy; translating the latest scientific evidence into practical nutrition recommendations; tracking and documenting outcomes into the Electronic Medical Record; providing nutrition education in the form of classes or seminars and via the internet to remote QuadMed locations; developing resources to support educational efforts; and maintaining professional capability and skills required for professional practice. This individual will collaborate with multidisciplinary teams and medical staff. KEY RESPONSIBILITIES - Conducts nutritional assessments and obtains nutrition history from patients. - Consults with physician and other healthcare staff to determine patients' nutritional needs and diet restrictions. - Formulates menus for therapeutic diets based on medical and physical condition of patients. - Develops and implements a plan of care based on assessment of nutritional needs and available resources. Correlates nutrition plan with other healthcare needs. - Instructs patients on meal plan and dietary changes. Establishes goals and objectives to help meet the plan. - Maintains confidentiality of all patient information - Evaluates nutritional care and provides follow-up continuity of care - Accurately documents nutrition care plans and information into patient's medical record - Instructs patients and their families in nutritional principles, dietary plans, food selection, and preparation. - Refer patients to other sources as needed or requested. - Performs other position related duties as assigned depending on assignment setting. JOB REQUIREMENTS Education: - Graduate of an ACEND-accredited dietetic program) B.S., B.A., or M.A. in Nutritional Sciences, Community Nutrition, Dietetics, or Public Health Nutrition) Experience: - Minimum two (2) years of experience in a clinical setting or completion of an internship through a coordinated program in dietetics in lieu of experience. Certificates, Licenses, Registrations: - Current RD/RDN license, in good standing with the state licensing board. - Current CPR (BLS) certification or must be obtained within 60 days of hire. Knowledge, Skills & Abilities: - Knowledge of industry researched best practices application and stays current with continuing education - Knowledge and ability to use computers with Windows - based business software applications (i.e.; Microsoft Word, Outlook, Excel, etc.) - Electronic Medical Record experience preferred - Skill in oral and written communication - Effective organizational skills including the ability to manage multiple projects at the same time and adaptability to changing priorities to meet demands - Ability to establish and maintain effective working relations - Ability to work independently - Bilingual a plus (English & Spanish preferred) - Proven ability to work effectively with diverse populations and a demonstrated commitment to fostering inclusion. Harry Quadracci was determined to do things differently, and to do them better. In 1991, the visionary print manufacturing CEO founded QuadMed out of the belief that there had to be a better way to provide his employees with access to affordable, high-quality health care. And what started as doing the right thing, ended up sparking a health care revolution. Now 30 years later, we partner with employers across the nation to provide value-driven health and wellness services in or near the workplace. With a focus on breaking down cost, access and quality barriers, we empower employees and their families to live healthier, happier lives. We offer excellent benefits to eligible employees, including 401(k), holidays, vacations and more. QuadMed and Quad is proud to be an equal opportunity employer. We are committed to creating a place of belonging - a space where employees do not need to sacrifice who they are to exist and grow in our workplace. QuadMed and Quad does not discriminate on any unlawful basis including race, religion, color, national origin, disability, gender, gender identity, sexual orientation, age, marital status, veteran status, genetic information, or any other basis prohibited by applicable federal, state, or local laws. QuadMed and Quad also prohibits harassment of applicants and employees based on any of these protected categories. Drug Free Workplace


