Access Management Specialist Jobs in st paul minnesota

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Access Management Program Specialist Job

Blue Cross and Blue Shield of Minnesota in Saint Paul, MN
14 Days agoInsurance                                                                                                                       ***   SIGN ON BONUS AVAILABLE   *** About Blue Cross Founded in 1933, Blue Cross and Blue Shield of Minnesota is the largest health plan in the state. We have more members, the largest network of providers and more products and services than any other plan in Minnesota. From the beginning, Blue Cross has been an innovator with a mission of making a healthy difference in people ’ s lives. We understand the importance of finding a job that you truly enjoy — at a company that shares your values. We ’ ve made it easy to feel good about working at Blue Cross by encouraging volunteerism, valuing diversity and offering the flexibility you need to live a balanced life. We offer a suite of comprehensive medical and dental benefits as well as competitive pay, flexible work schedules and generous personal paid time off in addition to 20 hours of volunteer paid time off each year. We look forward to serving Minnesotans over the next 80 years and beyond. Join us and make a healthy difference through the work you do every day. Description Summary The Access Management Program Specialist (AM Specialist) is a critical component of BCBS of MN ’ s Medical Management team. More administrative support roles have been hired to allow these clinicians to focus on working with members and providers.   The AM Specialist functions as a program manager by involving the community in coordinating care with other community resources.   For instance, working with state resources and discharge planners in the hospital to ensure the best care and outcomes for our BCBS Medicaid members. The AM Specialist will also collaborate face to face with providers in the emergency department and clinics to ensure they are educated about this new clinical model provided by Blue Cross. This role requires an advance practice RN, Public Health Nurse that can work in the community and promote better outcomes in our Medicaid population.   The best candidates will be those who enjoy building relationships .   The candidate will be energized by being present in the community and using critical thinking skills to be innovative with managing this program.   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   …
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