RN Specialist - Access Management Job:
Blue Cross and Blue Shield of Minnesota

20561-en_US
Blue Cross and Blue Shield of Minnesota
Eagan Minnesota
Healthcare
Description

About Blue Cross



For more than 80 years, Blue Cross and Blue Shield of Minnesota has worked to improve the health of all Minnesotans. As a nonprofit organization, we have a long history of making a healthy difference in people’s lives and of giving back to the communities we serve. In particular, our industry-leading commitment to veterans, service members and their families helped us to be named the first and only Beyond the Yellow Ribbon health plan company in Minnesota.



We make it easy for you to support veterans groups and other community organizations by providing 20 hours of volunteer paid time off each year — in addition to regular paid time off. The dedication of Blue Cross volunteers has earned us recognition for running one of the most successful corporate food drives in the state; donating nearly 1,500 volunteer hours at Habitat for Humanity worksites; and growing more than 750 pounds of fresh produce at our onsite Community Giving Gardens. Find your place at a company that cares about veterans, our employees, our members and our communities.


Description Summary

The Access Management Program Specialist is a critical component of BCBSM’s Medical Management team. The position is responsbile for supporting members enrolled in and the overall performance of the Restricted Recipient Program (RRP). This role functions as a part of a multidisciplinary team that is accountable for the overall program performance, and for our compliance to the core component of the Restricted Recipient program as defined by DHS and BCBSMN.  This role includes education, service coordination, benefit management, auditing, monitoring and program referrals. The Access Management Program Specialist is a complex role with multiple challenges.


Accountabilities

1. Serves on clinical interdisciplinary team which identifies and approves restrictions or exceptions for those individuals that may benefit from the Restricted Recipient Program, or who are currently enrolled.



2. Provides clinical oversight of the ongoing management of members in RRP.  Uses critical and clinical thinking skills to review claims and other clinical data in order to determine appropriate adherence to program guidelines.  Identifies potential clinical issues for escalation to the Behavioral Health Medical Director and RRP Clinical Governance. 



3.  Accountable for overall program performance as evidenced by quality metrics and outcomes, and through internal and external audit performance.



4. Coordinates care across member’s health care team as needed to minimize risk of harm to self or inappropriate usage of services.  This could include coordination with primary care, pharmacies, community and county resources, and emergency room facilities. 



5.  Acts as a point of contact for RRP program information for providers and facilities.



6. Educates members on the appropriate usage of health care services that maximize their outcomes and refers members to other programs as needed.



7. Maintains outstanding level of service at all points of customer contact.


Requirements


  • RN with MN license, with no restrictions.

  • PHN certification or ability to obtain PHN certification within 3 months. 

  • 5 years of relevant experience (Emergency Department, Public Health or Community Social Services, direct clinical experience with the Medicaid population).

  • 3 years of managed care experience; e.g. case management, utilization management.

  • Process and/or project management experience.

  • Outstanding communication skills, analytical thinking skills and task facilitation skills.


Preferred Requirements


  • Outstanding telephonic skills.

  • LADC.


FLSA Status

Exempt


Blue Cross Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.



 



Make a difference



Thank you for your interest in Blue Cross. Be part of a company that lets you be you — and make a healthy difference in people’s lives every day



Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.



Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association

Basic Qualifications
Requirement