Wellmark Blue Cross Blue Shield Advanced Care Nurse - RN (Full Time) in Des Moines, Iowa

Job Summary:

Are you a dedicated, caring health care professional motivated and inspired by the opportunity to provide ongoing personalized support and education to our members? Do you thrive in fast-paced work environments where your time management, prioritization, and multi-tasking skills are critical to success? If so, consider applying today!

Our Advanced Care Nurse proactively identifies and provides telephonic complex care management interventions for members. This includes completing assessments to identify barriers to care and gaps in health care, and creating and managing individual care plans that ensure members receive appropriate care and achieve health care goals. Our team collaborates with members, members’ families, health care providers and community resources to coordinate care and services provided to members.

**This position is located in our Des Moines, IA office.

**This role requires the ability to work a flexible schedule with shifts between the core hours of 8:30 a.m. – 7:00 p.m. Monday – Friday. This will include 2 shifts 10:30 a.m. – 7:00 p.m., 1 shift 9:30 a.m. – 6:00 p.m. & 2 shifts 8:30 a.m. – 5:00 p.m. and is subject to change based on business needs.

Core Competencies:

  • Accountability: Owning and taking responsibility for one’s actions.

  • Business Acumen: Understanding industry, market, financial and company specific operations.

  • Collaboration and Communication: Working together; listen to other’s ideas; communicate accurately and concisely.

  • Decision Making: Consider all facts and impacts when making decisions.

  • Focus on the Customer: Consistently doing what is in the best interest of our customer. Leaving a positive impression on the customer by elevating their experience; making it simpler and educating to helping them understand.

Minimum Qualifications Required (all must be met to be considered):

  • Active and unrestricted RN license in Iowa or South Dakota; individual must be licensed in the state in which they reside.

  • 4+ years of clinical experience in an acute care or outpatient setting with a minimum of 4 years full-time equivalent of direct clinical care to the consumer.

  • Strong verbal and written communication skills, including the ability to influence others and negotiate care with members, physicians, care facilities, or similar audiences.

  • Ability to effectively establish relationships and engage with patients/members through telephonic communication.

  • Knowledge of regulatory standards and regulations – e.g., URAC, NCQA, HIPAA, PHI, confidentiality.

  • Experience with computer software applications – e.g., Microsoft Office Suite, electronic charting, documentation systems.

  • Analytical problem solving skills with the ability to think critically and make independent decisions.

  • Ability to work in a fast-paced environment where production and/or quality goals are measured. Demonstrated commitment to timeliness, follow up, effective prioritization, accuracy, and attention to detail.

  • Ability to travel as needed (5%). Valid driver's license required.

  • Certification as a Certified Case Manager (CCM). Must attain CCM within 24 months after hire and maintain throughout employment.

Hiring Specifications Preferred:

  • Bachelor's Degree in Nursing, Health Care Administration, or Public Health.

  • Previous work experience in case management, including assessment of members, creation and management of care plans, etc.

  • Previous experience working independently and managing an assigned caseload in a metrics-based environment.

  • Demonstrated experience interpreting health care benefits.

Job Accountabilities:

a. Proactively coordinate care for high risk members and/or members that are identified with potential high risk, complex conditions through focused intervention and effective planning techniques. This includes assessing members to identify care needs, barriers & interventions. In collaboration with the member and the members health care delivery team, create, manage and update individualized intervention-based care plans.b. Effectively engage members in the participation of the case management plan and educate members on their accountability and expected outcomes, including services and benefits appropriate to their current medical status.c. Monitor results and trends and make recommendations to leaders/advisory team/groups as appropriate regarding change.d. Actively research and stay abreast of appropriate resources and/or programs that may help to improve the health of the member. Collaborate with and facilitate referrals to providers, community resources/programs and Wellmark programs as necessary.e. Meet caseload expectations for work area assigned through predetermined case identification logic. Accepts referrals from other programs and from within the advanced care management area. Meet both quality assurance and production metrics as established by the advanced care management unit.f. Document case findings accurately, consistently and timely by following the standard work guidelines and policies to support internal and external processes.g. Collaborate with and facilitate referrals to providers, community resources/programs and Wellmark programs to improve the health of the member. Comply with regulatory standards, accreditation standards and internal guidelines remain current and consistent with the standards pertinent to the Case Manager team.h. Provide education to the member on services and benefits appropriate to their current health status and needs regarding their support care. Reduce barriers in the health care delivery system to ensure the member has access to and uses appropriate, quality, health care services by matching the services to the members needs, avoiding duplication of effort and improving provider/member communication.i. Participate in cross-collaboration among health and care management teams and stakeholders across divisions as required to provide optimal service to the member.j. Other duties as assigned.

Job ID 212580

Location US-IA-Des Moines

Category Clinical/Provider Support

Requires Non-Compete? No