What are the responsibilities and job description for the ACHN RN Care Manager position at Blue Cross and Blue Shield of Alabama?
Overview
Department Overview
Our subsidiary is responsible for coordinating care for healthy eligible individuals, those with multiple chronic conditions, pregnant women, and men and women needing family planning. The goal of the program is to ensure an effective and efficient delivery of care. This area works with low income populations to improve the quality of care programs and community outreach.
Primary Responsibilities
- Conduct facility, and home visits on assigned recipients in order to complete screenings and assessments to ensure appropriate home based support and services are available
- Provides support to recipients transitioning from one care setting to another by leading or participating in the Transitional Care team, serving as the primary Care Coordinator and addressing clinical needs
- Collaborate with medical, behavioral health and/or community resource providers to create a sound foundation for the care plan
- Consult with the Multidisciplinary Care Team (MCT) to develop and implement patient centered holistic care plans
- Improve recipients or client’s health outcomes by promoting quality assurance
- Ensures timely assignment and completion of care management tasks
- Ensures compliance with state performance metrics and goals
- Reduce inappropriate utilization and costs associated with emergency department and hospital inpatient services
- Supports staff and Primary Care Providers (PCPs) to ensure appropriate services are provided to enrolled EIs or clients
- Supports enhancement of Medicaid services provided to recipients or clients
- Meet AlaHealth and Medicaid requirements for charting and audit requirements
- Accomplishes all assigned job functions in a manner that optimizes departmental effectiveness while maintaining confidentiality
Note: This is a field-based position with required travel in the Northwest region of the Alabama Coordinated Health Network (ACHN). The incumbent will travel daily to serve members in their local area. The Northwest Region of the Alabama Coordinated Health Network (ACHN) supports members in the following counties: Lauderdale, Colbert, Lawrence, Franklin, Marion, Winston, Walker, Fayette, Lamar, Tuscaloosa, Pickens, Bibb, Hale, Greene and Sumter. The incumbent should live within or in close proximity to the counties outlined in the coverage area.
Summary of Qualifications
- Bachelors of Science in Nursing or Associate Degree or Diploma in Nursing
Specific requirements for Associate Degree in Nursing (ADN) only:
- Must have two (2) years of recent experience working in a clinic setting or combined hospital experience; and
- Minimum on one (1) year experience in care coordination/case management working with low-income and diverse populations; must include experience working with individuals in Medicaid populations receiving care coordination/case management services.
- Active Alabama license in good standing as a Registered Nurse (RN)
- Must live and work within the region or adjoining county
- Have strong verbal and written communication skills to encourage and engage recipients in plan of care
- Ability to sufficiently document electronic case records including writing effective care plans and SMART goals
- Ability to manage a heavy caseload
- Experience analyzing clinical situations and making informed decisions
- Experience in a position demonstrating exceptional written, verbal and interpersonal communications
- Experience in a position exercising independent judgement and decision making
- Experience in a position working with medical providers and/or community resource agencies
- Willingness to travel as required for the job
- Two years of complex pediatric experience preferred
- Experience working in a home setting as a Case Manager or Care Coordinator preferred
- Knowledge of Alabama Medicaid regulations and guidelines preferred
- Knowledge of community based agencies and resources is preferred preferred
Terms and Agreements
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