Population Health RN Part-Time

About the position

The Population Health RN position at Blue Cross Blue Shield of Louisiana is a part-time role focused on organizing, coordinating, and providing care coordination and case management services to members who are at high risk for health deterioration, sentinel events, and poor outcomes. The nurse will manage both acute and chronically ill members, aiming to improve their health and financial outcomes through a thorough analysis of their needs and the design and delivery of tailored interventions. This role requires a collaborative approach to assess, plan, implement, monitor, and evaluate the options and services necessary to meet the healthcare needs of members. The nurse will utilize effective communication to identify available resources that promote quality and cost-effective outcomes, ensuring compliance with all relevant laws, regulations, and accreditation standards associated with their responsibilities. In this role, the nurse will not manage other staff but will work closely with various stakeholders, including Benefits Administration, Medical Directors, and community resources, to fulfill their duties effectively. The position requires a Bachelor's degree in nursing, business administration, healthcare, or a related field, or an RN license with relevant experience. The nurse will be responsible for assessing members' situations, developing comprehensive case management plans, and implementing specific activities to achieve established goals. They will also evaluate the effectiveness of these plans and modify them as necessary, utilizing behavioral interviewing techniques and adhering to guidelines for service authorizations related to complex cases. The role emphasizes the importance of quality performance standards and participation in quality improvement projects to enhance the Population Health Program.

Responsibilities
? Organize, coordinate, and provide care coordination and case management services to at-risk members.
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? Manage acute and chronically ill members to improve health and financial outcomes.
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? Utilize a collaborative process to assess, plan, implement, monitor, and evaluate healthcare options and services.
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? Identify available resources to promote quality and cost-effective outcomes.
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? Assess member's status by collecting in-depth information to identify individual needs.
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? Develop and implement comprehensive case management plans with specific objectives and actions.
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? Act as an advocate for members and families, maintaining privacy and confidentiality.
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? Coordinate care by collaborating with members, providers, and community resources.
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? Evaluate the effectiveness of case management plans and modify as necessary.
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? Participate in Quality Improvement projects and data collection for the Population Health Program.

Requirements
? Bachelor's degree in nursing, business administration, healthcare, or a related field is required.
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? RN license to practice in Louisiana is required; RN license in other states preferred.
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? 3 years of recent direct patient care/clinical experience is required.
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? 2 years of experience in managed care is preferred.
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? Experience in behavioral interviewing techniques and theory is required.
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? Ability to prioritize, work independently, and make decisions is necessary.
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? Knowledge of standardized code sets and medical terminology is required.
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? Excellent interpersonal, organizational, analytical, and telephonic skills are required.
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? Strong communication skills to explain claims information to varied audiences are necessary.

Nice-to-haves
? Certified Professional in Health Care Management preferred.
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? Chronic Disease Management Certification preferred.
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? Case Management Certification preferred.

Benefits
? Competitive hourly wage between $29 - $36.
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? Opportunities for professional development and continued learning.
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? Supportive work environment promoting health and well-being.

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