Blue Cross and Blue Shield of Minnesota · 1 day ago
RN Specialist Cmplx CM
United States
Full-time
Remote
Senior Level
$79K/yr - $130K/yr
5+ years expBlue Cross and Blue Shield of Minnesota is dedicated to transforming healthcare and achieving the healthiest life for everyone. They are seeking an RN Specialist who will utilize case management principles to analyze members' health needs and collaborate with care teams to develop effective care plans, aiming to avoid unnecessary hospitalizations and optimize care delivery.
Insurance
Responsibilities
Receives referral for member identified with high cost, complex medical conditions and telephonically outreaches to the member, family and providers to engage in complex case management program
Conducts clinical assessments with members and providers utilizing motivational interviewing; gathers, analyzes, synthesizes and prioritizes member needs and opportunities based upon the clinical assessment and research and collaborates with the interdisciplinary care team to develop a comprehensive plan of care
Collaborates and communicates with the health care team; e.g. member, family, designated representative, health care provider on a plan of care that produces positive clinical results and promotes high–quality, cost effective outcomes
Identifies relevant BCBSMN and community resources and facilitates program and network referrals
Monitors, evaluates, and updates plan of care over time
Ensures member data is documented according to BCBSMN application protocol and regulatory standards
Maintains outstanding level of service at all points of customer contact
Understands the strategic and financial goals of the department, complex care management teams, and the enterprise
Knowledgeable of health plan operations (e.g. networks, eligibility, benefits)
Promotes innovative solutions to improve day to day functions and enhance the overall operation of the department
Collaborates with interdisciplinary care team to develop a comprehensive plan of care to identify key strategic interventions to address member’s needs and health care cost drivers
Engage providers telephonically in reviewing and understanding treatment plans, including alignment with benefits and medical reimbursement policies to facilitate optimal treatment plans, care coordination, and transition of care between settings
Identifies and implements cost saving opportunities to ensure optimal and cost-effective health outcomes
Qualification
Required
Registered nurse with current MN license and with no restrictions
All relevant experience including work, education, transferable skills, and military experience will be considered
5 years relevant clinical care experience
CCM Certificate or ability to obtain within 3 years of starting in the position
Excellent telephonic skills
Keen business skills
Excellent communication skills
Excellent conceptual thinking skills
Excellent relationship management skills
Excellent organizational skills
Computer application proficiency
Strong resiliency and flexibility skills
Excellent research, analytical, and creative problem-solving skills
Flexibility to work varied hours
High school diploma (or equivalency) and legal authorization to work in the U.S
Preferred
2+ years of managed care experience; e.g. case management/health coach, utilization management and/or auditing experience (may be included in the 5 years relevant clinical experience)
Benefits
Medical, dental, and vision insurance
Life insurance
401k
Paid Time Off (PTO)
Volunteer Paid Time Off (VPTO)
And more
Company
Blue Cross and Blue Shield of Minnesota
About Blue Cross Blue Cross and Blue Shield of Minnesota is a taxable, nonprofit organization with a mission to make a healthy difference in people’s lives.
1001-5000 employees
H1B Sponsorship
Blue Cross and Blue Shield of Minnesota has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
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Trends of Total Sponsorships
2025 (4)
2024 (4)
2023 (6)
2022 (2)
2021 (3)
2020 (5)
Funding
Current Stage
Late StageLeadership Team
Carrie S. Lawrence
Executive Administrator to the President & CEO and Chief of Staff
Patsy Riley
Chief Goverment Officer and Senior Vice President and CEO, ClearStone Solutions
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