Job DescriptionJob SummaryThis key position is responsible for assisting members within a geographical (local, statewide and/or other) area make effective health care choices for self-management of their acute and /or chronic condition(s). Utilizing a member-centric approach they assist members and their families understand and manage their disease process by: reinforcing the physicians' plan of treatment, promoting healthy behaviors and lifestyle changes, and providing education and tools to promote self- management to improve health outcomes and reduce overall costs. Individual care plans are developed in collaboration with the Physician, Member/Care Giver, Families and the Care Team. Ongoing coaching, monitoring and evaluation of care plans will be done face to face with the member, telephonically, digital engagement or electronically through email and member and provider portals.
Essential Functions- The essential functions listed represent the major duties of this role, additional duties may be assigned.
- Engage Members telephonically, using digital engagement tools and/or face to face at Florida Blue Retail Centers, hospitals, etc. with a focus on health coaching and member education. Facilitate access to care and resources to meet the member's health care needs. Provide education and tools to promote self-management.
- Plan, implement, coordinate and monitor Case Management activities that may include acute and non-acute services, outpatient services, behavioral health and / or community resources.
- Facilitate care for high risk members across the continuum of the health care experience, including care transitions, coordination of community and social service and coordinating with other value-based organizations, providers as needed.
- Close gaps in care
- Conduct Medication Reconciliation
- Collaborate with Member, Member's Physicians, Plan Medical Directors, Managers, Local, Regional and Specialty team members as well as other functional areas to assist the member to meet their health care goals.
- Promote healthy lifestyles, assist in strengthening the patient-physician relationship, encourage behavior and lifestyle changes to realize a better quality of life, for individuals with identified chronic conditions, costly and/or catastrophic illnesses.
- Assist Members and their physicians to navigate through the health continuum, educate regarding benefits, identify candidates for Care Programs and provide information pertaining to the network and network access.
QualificationsRequired Work Experience- 2+ years related work experience in Communicating and building relationships with members/providers/employers both telephonically as well as live
- Related Bachelor's degree or additional related equivalent work experience
- RN - Registered Nurse - State Licensure And/Or Compact State Licensure
- Experience with influencing and motivating individuals to change health behaviors
- Knowledge and/or experience with population health
- Experience in two or more of the following: home health care, utilization review, discharge planning, disease/ case management
- Experience working with Managed Care products, benefits and services
- Experience in planning, implementing coordinating and monitoring activities that focus on acute and non-acute services, outpatient services and/or community resources for all lines of business
- Non-traditional working hours to meet the member's availability
- Basic to intermediate experience in MS Word, Excel, tablet and/or smartphone
- Basic technology skills with digital tools and apps.
- Travel up to 30% (subject to change) for on-site member/provider/employer meetings, events or manager requests
- Must have valid driver's license and reliable transportation
Preferred - Bachelor's degree in a related field
- CCM - Certified Case Manager
- Bilingual English/Spanish and/or Creole
- Direct clinical experience (3-5 years)
- Experience working remotely (i.e. home office)
- Oncology, Geriatrics, Palliative and or End of life care experience
- Medicare Advantage products
General Physical Demands
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.
Physical/Environmental Activities
Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences). Occasionally
What We Offer: As a Florida Blue employee, you will be at the heart of GuideWell's vision - to lead the nation in transforming health through compassionate, connected, and technology-enabled care that delivers personalized value and empowered living.
To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:
- Medical, dental, vision, life and global travel health insurance;
- Income protection benefits: life insurance, short- and long-term disability programs;
- Leave programs to support personal circumstances;
- Retirement Savings Plan including employer match;
- Paid time off, volunteer time off, 10 holidays and 2 well-being days;
- Additional voluntary benefits available; and
- A comprehensive wellness program
Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.
To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.
Annualized Salary Range: $71,200 - $115,700
Typical Annualized Hiring Range: $71,200 - $89,000
Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.
