At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve.

Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, thereâ??s no greater time for forward-thinking professionals like you to join us in delivering on it!

As a member of Team Blue, youâ??ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.

As a member of Team Blue, youâ??ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.

BCBSNE is happy to offer four work designations for our Omaha area employees: 100% in-office, Hybrid options, and 100% remote. If choosing to work remote, this role can be located in one of the following states: Florida, Iowa, Kansas, Missouri, Nebraska, North Dakota, and Texas.

This position will engage our low to moderate risk members to improve health and financial outcomes through analysis of needs, design, and delivery of interventions. The Nurse Care Manager educates members to understand innovative benefit structures that promote transparency and affordability and empowers consumers to make informed decisions regarding their healthcare options, coverage, and financial risk. This role supports members in developing self-management skills and adopting positive behavior changes, identifies and addresses barriers to memberâ??s adherence to standards of evidence-based medicine. Identifies resources to assist members in achieving their personal health goals, and proactively incorporates lifestyle improvement and prevention opportunities into member interventions. This role supports members in navigating the healthcare system, including but not limited to preprocedural and post-discharge advocacy, education, and management.

What you'll do:

Educate members about their benefits and coverage, and guide members to appropriate programs, community resources, and in-network providers.
Screen and triage members for levels and types of nurse advocacy and medical management programs. Refers to appropriate programs accordingly.
Conduct clinical assessments and engage members through a variety of approaches that will include telephonic and mobile application interventions depending on the model of care delivery. Clinical assessments address the health and wellness needs of BCBSNE members using a broad set of clinical and motivational interviewing skills with the goal of effecting membersâ?? self-management and positive behavior changes.
Function as a Nurse Care Manager for members with medical needs with the goal to help develop and support the memberâ??s ability to self-manage and navigate the health care system and to provide members with resources and tools to assist in health-related decision making.
Responsible to collaborate and consult with healthcare providers, members, and internal teams.
Work with members at risk for post-discharge complications or potentially preventable readmissions and follow-up with members after return home to ensure member is able to obtain medically necessary care, understands discharge instructions and plan of care, understands warning signs of complications, and knows what actions to take to address changing health status.
Work with members through other outreach initiatives, including but not limited to members with chronic conditions and members who frequent the Emergency Room and identify potential barriers and solutions.
Maintains compliance requirements by knowing, understanding, and adhering to URAC accreditation standards and other regulatory requirements.
Responsible for maintaining professional licensure and practicing within the scope of licensure.

To be considered for this position, you must have:

Certified Practical Nurse.
The Licensed Practical Nurse Care Manager must hold a current, unrestricted Licensed Practical Nurse license from the state of Nebraska or a state in the consortium in which Nebraska participates.â??
Three (3) years clinical nursing practice experience in a health care setting.
Based on area of assignment, must be able to work rotating weekend/holiday shifts as needed.

The strongest candidates for this position will also possess:

Demonstrated previous experience working in Medicare Advantage and Managed Care organizations.
Clinical experience in multiple levels of care.
Certification in case management, managed care and/or health coaching.
Experience in discharge and/or preadmission planning.
Experience in Care Management.
Knowledge of accreditation standards and regulatory requirements.

Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers.

We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.

Blue Cross and Blue Shield of Nebraska is an Equal Opportunity /Affirmative Action Employer - Minorities/Females/Disabled/Veterans

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