Blue Cross and Blue Shield of Minnesota

Care Advocacy Case Manager RN

Blue Cross and Blue Shield of Minnesota  •  $131k/yr  •  Eagan, MN (Hybrid)  •  9 hours ago
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Job Description

About Blue Cross and Blue Shield of Minnesota

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us.

The Impact You Will Have

Provides dedicated telephonic support to members and accounts, ensuring seamless coordination of care and resolution of complex issues. This role goes beyond traditional case management by handling appeals, scheduling appointments, and collaborating with providers, pharmacists, and internal teams to deliver exceptional service and improve member outcomes.

What You’ll Do

  • Provides dedicated telephonic case management and care advocacy support, helping members navigate healthcare needs, resolve complex care issues, coordinate appointments, manage appeals, and connect with internal and external support programs.
  • Acts as a primary point of contact for assigned accounts, collaborating with providers, pharmacists, utilization management teams, and customer service to improve member outcomes, ensure seamless care coordination, and deliver high-touch concierge-level service.
  • Requires an active Minnesota RN license and significant case management experience, with responsibility for managing caseloads, documenting interventions, supporting audits, and using motivational interviewing techniques to drive member engagement and adherence to care plans.


How You’ll Do It

  • Conduct telephonic outreach to members, addressing health needs and resolving issues related to care, denials, and appeals.
  • Serve as a dedicated resource for assigned accounts, providing personalized support and ensuring high service standards.
  • Promote and refermemberstoaccountspecific external vendors as well as internal programs such aswellness coaching, behavioralhealthand other specialty case management whereappropriate
  • Maintainaccuratedocumentation of interactions and interventions to support compliance and quality standards.
  • Coordinate with providers,utilizationmanagement teams, and pharmacists tosupportappeals and resolve care-related challenges.
  • Utilize motivational interviewing techniques to encourage member engagementand promote adherence tocareplans.
  • Collaborate closely with account staff, and customer service tomaintainseamless communication and meet client expectations.
  • Effectively manage caseloadand ensuretimelyescalation to medical directorsor pharmacistsfor high-cost or complex cases.
  • Facilitate warm transfers and schedule appointments on behalf of members, delivering concierge-level service.
  • Prepare for and participate in client audits to demonstrate program performance and value.
  • Participate inpost-audit action plans,ask questions whereappropriateand integrate changes to improve case management practices.
  • Performs additional responsibilities consistent with the scope and level of the role, as assigned.

Required Skills & Experience

  • 5+ years of related case management (clinical) professional experience.
  • Bachelor’s degree; in lieu of a degree, an additional two years of relevant experience beyond the qualifications listed above may be accepted.
  • Registered nurse with current MN license and with no restrictions.
  • CCM Certification or ability to obtain within 3 years of starting in the position.

Preferred Skills & Experience

  • Ability to communicate complex topics clearly and concisely, actively listen to anticipate stakeholder needs, and align others to drive informed decisions.
  • Ability to analyze complex information, evaluate options, and work cross-functionally to drive resolution and prevent recurrence.
  • Ability to effectively organize work, balance competing priorities, and manage time across complex assignments and competing deadlines.

Licensure/Certifications

Required -
Registered Nurse License (RN) - MN Nursing Licensing Board

Preferred-
Certified Case Manager (CCM)

Role Designation

Remote

Teleworker

Role designation definition: Teleworking is working full time remote. Hybrid is a minimum of 2 days onsite. Onsite is full-time onsite.

Compensation and Benefits:

Pay Range: $79,100.00 - $104,800.00 - $130,500.00 Annual

Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.

We offer a comprehensive benefits package which may include:

  • Medical, dental, and vision insurance
  • Life insurance
  • 401k
  • Paid Time Off (PTO)
  • Volunteer Paid Time Off (VPTO)
  • And more

To discover more about what we have to offer, please review our benefits page

Equal Employment Opportunity Statement

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic.

Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: talent.acquisition@bluecrossmn.com.

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

Physical Requirements

Blue Cross and Blue Shield of Minnesota

About Blue Cross and Blue Shield of Minnesota

About Blue Cross

Blue Cross and Blue Shield of Minnesota is a taxable, nonprofit organization with a mission to make a healthy difference in people’s lives. Chartered in 1933 as Minnesota’s first health plan, we’ve promoted wider, more economical and timely availability of health services for the people of Minnesota for 90+ years.

Blue Cross® and Blue Shield® of Minnesota is a nonprofit independent licensee of the Blue Cross® and Blue Shield® Association.

Terms of Use

All comments, visuals, videos and other type of material posted by fans on this site do not necessarily reflect the opinions or ideals of Blue Cross and Blue Shield of Minnesota (“Blue Cross”), its employees or affiliates. THIS SITE SHOULD NOT BE USED TO CONTACT BLUE CROSS ABOUT ANY CLAIM, MEDICAL CONDITION, PRODUCT OR SERVICE OFFERED BY BLUE CROSS. Blue Cross (a) does not represent or warrant the accuracy of any statement, product or service claims made here, (b) is not responsible for any such content on this site, and (c) does not endorse any opinions expressed on this site.

All materials and comments posted by users must comply with LinkedIn’s Terms of Use. Blue Cross does not monitor every posting on this site. Blue Cross expects, however, that users will not post any comments or material that falls into any of the following categories and may have removed any comments or materials that:

•Defame, abuse, harass, stalk, threaten or otherwise violate the legal rights (such as rights of privacy and publicity) of others.

•Publish, post, distribute or disseminate any defamatory, infringing, obscene, indecent, misleading or unlawful material or information.

Industry
Finance & Insurance
Company Size
1,001-5,000 employees
Headquarters
Eagan, MN
Year Founded
Unknown
Website
bluecrossmn.com
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