Description

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.


Blue Cross and Blue Shield of Minnesota

Position Title: Clinical Guide
Location: Remote
Career Area: Health Services


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

The Clinical Guide is a critical component of BCBSMs Integrated Health Management team. The position exists to provide member, provider and delegate resourcing; e.g. problem solving, benefit management, education and program referrals. Additionally, the Clinical Guide serves as a subject matter expert to team members and BCBSMN.

Your Responsibilities

• Responds to member, provider, customer service, company, and external partner referrals and/or questions. Provides referrals, education, and support coordination to appropriate community resources.
• Evaluates members needs to assess the member's needs, identify, and vet resources to support the member holistically. Facilitates referrals to Case Management Programs as appropriate.
• Gathers accurate and comprehensive information required for benefit and/or member management.
• Serves as a resource to members and their families, e.g. navigating services in the health care system as well as to other business units for unique and/or complex cases.
• Collaborates and coordinates with team members to facilitate day to day functions and enhance the overall operation of the department.
• Ensures member data is documented according to BCBSMN application protocol and regulatory standards.
• Maintains outstanding level of service at all points of customer contact.
• Understands broad-based goals of assigned market segment(s) including clinical and service availability.

Required Skills and Experience

• RN with MN license or LSW with no restrictions
• 3 years relevant clinical experience
• 1+ years of medical call center or managed care experience; e.g. case management, utilization management
• All relevant experience including work, education, transferable skills, and military experience will be considered
• Outstanding communication skills
• Outstanding analytical thinking skills
• Outstanding task facilitation skill
• Strong computer application skills
• Medicare and/or Public Programs experience
• High school diploma (or equivalency) and legal authorization to work in the U.S.

Compensation and Benefits:

Pay Range: $67,200.00 - $89,100.00 - $111,000.00 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.

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