ACHN RN Care Manager

Blue Cross and Blue Shield of Alabama - Tuscaloosa County, AL

Job Title: ACHN RN Care Manager

Position: Registered Nurse

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Location

Address:

City: Tuscaloosa County

State: AL

ZIP Code:

Job Responsibilities

Conduct facility and home visits on assigned recipients to complete screenings and assessments to ensure appropriate home-based support and services are available.
Provide 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 clients' health outcomes by promoting quality assurance.
Ensure timely assignment and completion of care management tasks.
Ensure compliance with state performance metrics and goals.
Reduce inappropriate utilization and costs associated with emergency department and hospital inpatient services.
Support staff and Primary Care Providers (PCPs) to ensure appropriate services are provided to enrolled EIs or clients.
Support enhancement of Medicaid services provided to recipients or clients.
Meet subsidiary and Medicaid requirements for charting and audit requirements.
Accomplish all assigned job functions in a manner that optimizes departmental effectiveness while maintaining confidentiality.

Required Skills

Core Skills

Strong verbal and written communication skills
Ability to document electronic case records
Experience analyzing clinical situations
Independently exercising judgment and decision-making abilities
Managing a heavy caseload

Preferred Skills

Two years of complex pediatric experience
Experience working in a home setting as a Case Manager or Care Coordinator
Knowledge of Alabama Medicaid regulations and guidelines
Knowledge of community-based agencies and resources
Experience working in a behavioral health hospital or residential facility

Requirements

Experience: Two (2) years of recent experience working in a clinic setting or combined hospital experience; minimum of one (1) year experience in care coordination/case management working with low-income and diverse populations.

Education: Bachelors of Science in Nursing or Associate Degree or Diploma in Nursing

License & Certification:

Active Alabama license in good standing as a Registered Nurse (RN)

Schedule:

COVID-19 Requirements: Not Specified

Benefits

Not specified

Supplemental Pay

Not specified

Special Notes

The Company does not discriminate in hiring or employment on the basis of race, color, religion, creed, sex, sexual orientation, gender identity, national origin, age, disability, genetics, status as a disabled or protected veteran, or citizenship status.

Facility Details

Name: Blue Cross and Blue Shield of Alabama

Description: Responsible for coordinating care for healthy eligible individuals, those with multiple chronic conditions, pregnant women, and men and women needing family planning.

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