We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross.

Please note that effective Jan. 4, 2022, Blue Cross and Blue Shield of Louisiana implemented a policy requiring any employee who enters any of our offices or who interacts in person with anyone for company business purposes to be fully vaccinated for COVID 19, unless legally entitled to a reasonable accommodation related to religious or medical exemptions. At this time, that policy is suspended and vaccination is not required to enter our facilities. Please note this is subject to change at any point in time to ensure compliance with company policy or government mandates and certain client facing roles may have separate protocols.

Residency in or relocation to Louisiana is preferred for all positions.

Job Summary:

Blue Cross Blue Shield’s Dual Plus Plan is an All-Dual Eligible Special Needs Plan (D-SNP) providing focused care for members that have Medicare and are also entitled to Medicaid. The D-SNP Case Manager position is responsible for conducting case management, care coordination and quality activities in accordance to CMS standards and Blue Cross Blue Shield’s policies and procedures. The position responsibilities include the management of assigned cases to ensure quality of care is maintained as the patient accesses care and services in the continuum of care. The case manager telephonically assesses D-SNP members by evaluating member needs and requirements in order to achieve and/or maintain optimal wellness state. The D-SNP Case Manager will evaluate D-SNP enrollees for resource needs and guide members and their families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The D-SNP Case Manager will work in collaboration with the member, the member’s care providers and a multi-disciplinary team, employing a variety of strategies, approaches and techniques to manage a member’s physical, environmental and psycho-social health issues.

Essential Duties & Responsibilities:

• Adheres to Dual Plus Plan Model of Care program goals and objectives to meet the member’s individualized health care needs through adherence to program policies and procedures.
• Actively participates in all enrollment activities.
• Performs telephonic case management and care coordination activities, communicating with the multidisciplinary team.
• Reviews each case individually and evaluates for referral to Social Services, Behavioral Health, Disease Management, community resources and other resource needs.
• Collects pertinent clinical information (including claims data when available), documenting findings using the Acuity case management system.
• Evaluates and completes the Health Risk Assessment which includes physical, psychological, emotional and environmental assessments, for the purpose of providing appropriate, timely interventions to ensure provision of optimal care.
• Coordinates community care and services as deemed appropriate.
• Develops an individualized care plan for each member along with the member and/or family and through collaboration with the Interdisciplinary Care Team (ICT).
• Provides ongoing evaluation and management of the member’s progress, effectives of the care plan, as well as, the efficacy and appropriateness of services provided.
• Works collaboratively with other members of the Care Interdisciplinary Care Team to include: Case Managers, Social Services, Field Care Managers, Transitional Care, Behavioral Health and providers including the members’ Physician(s) and other healthcare providers.
• Consults and collaborates with the Medical Director of Case Management as needed regarding member cases related to appropriateness of care, evidenced based clinical guidelines, medications and other treatment plans, individualized care plans and resource needs required to meet/manage the member’s level of care.
• Active member of the Interdisciplinary Care Team and actively participates in the ICT meetings.
• Understands clinical program design, implementation, and management, monitoring and reporting.
• Participates in quality improvement processes
• Complies with performance and reporting standards as defined by Blue Cross Blue Shield and CMS.
• Serves as a liaison and patient advocate when deemed applicable or as requested by the patient or patient’s legally appointed representative.
• Additional responsibilities as deemed appropriate by Case Management leadership.

Marginal Duties:

• Assists, as needed, with other duties in the role and is flexible to new ideas.
• Participates as needed on the QI Committee, Case Management Committee and D-SNP Quality Committee.
• Able to work in several computer program systems, and document electronically.
• Able to work independently and interdepartmentally to meet departmental and organizational goals.
• Other duties as assigned.

Key Competencies:

• Accountability – meets established expectations and takes responsibility for achieving results; encourages others to do the same. Employs focus, attention to detail, reliability, and appropriate prioritization to drive outcomes. Sees opportunities to contribute and takes the initiative to create solutions.
• Builds trust – consistently models and inspires high levels of integrity in decisions, speech, and actions. Lives up to commitments, taking responsibility for the impact of one’s actions. Prioritizes principles and values over personal or professional gain.
• Customer Focus – connects meaningfully with customers to build emotional engagement and customer advocacy. Develops and applies deep customer knowledge and intimacy to develop and deliver products, services, and interactions that provide value beyond expectations.
• Executes for results – effectively leverages resources to create exceptional outcomes. Determines the best course of action when facing ambiguity. Anticipates and constructively resolves barriers and constraints. Embraces change, applies new knowledge and reconfigures quickly to capitalize on opportunities.
• Understands or becomes knowledgeable of quality monitoring and improvement activities.

Knowledge, Skills, and Abilities:

• Graduate of an accredited school of Nursing with current unrestricted license to practice as an RN is required.
• Current Compact License or have the ability to obtain a Compact License within 90 days of hire is required.

• Three plus years of general clinical experience required.
• One plus years of clinical experience in case management, acute hospital discharge planning or utilization review is a plus, but not required.
• Previous direct clinical care to patients in a behavioral health setting is a plus, but not required
• Current Case Management Certification is a plus, but not required
• Exceptional interpersonal, verbal, and written communication skills
• Concise, clear documentation skills
• Strong problem-solving skills

• Ability to work with limited supervision and make decisions based on established policies and procedures

Supervisory Responsibilities:

• None

Supervision Received:

• Works under the direct supervision of the Case Management Manager and Supervisor
• Works under general supervision of the Case Management Coordinator

Working Conditions:

• Overtime will be occasionally required.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit, use hands and fingers, handle or feel, reach with hands and arms, and talk or hear. The employee is frequently required to stand and walk. The employee must regularly lift and/or move up to 10 pounds and frequently lift and/or move up to 25 pounds.

Additional Accountabilities and Essential Functions

The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions

• Perform other job-related duties as assigned, within your scope of responsibilities.
• Job duties are performed in a normal and clean office environment with normal noise levels.
• Work is predominately done while standing or sitting.
• The ability to comprehend, document, calculate, visualize, and analyze are required.

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An Equal Opportunity Employer

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Additional Information

Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account.

If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance.

In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.

Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.

Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.